Voice outcome after type-1 thyroplasty for unilateral vocal cord paralysis: our experience at tertiary care hospital
Keywords:Maximum phonation time, Psychoacoustic analysis, Silicone implant, Stroboscope, Unilateral vocal cord palsy
Background: Vocal cord paralysis is a clinical sign caused by paralysis of intrinsic muscles of larynx due to dysfunction of recurrent laryngeal nerve or injury to the vagus nerve. One of the common and effective methods of medialization is by using silicone implants. This study was aimed at prospectively assessing and analysing the vocal outcomes and quality of life of patients in type 1 medialization thyroplasty using silicone implants.
Methods: Prospective study of 18 months was done on 17 patients with unilateral vocal cord paralysis. Surgical procedure for the patients was standardized by using silicon implant to medialize the cord. The parameters used for the pre and post treatment objective analysis were stroboscopic analysis, psychoacoustic evaluation, maximum phonation time (MPT) and patient’s self-assessment.
Results: In our study all 17 patients with unilateral vocal cord paralysis who were subjected to vocal cord medialization using silicone implant showed a statistically highly significant improvement in all the parameters of assessment. The mean preoperative MPT was 7.260 and post-operative MPT showed significant improvement and was 17.428 seconds. mean preoperative GRBAS score was 11.695 and post-operative was 3.826. Similarly, pre op vocal handicap index was 31.173 which decreased significantly after the procedure was 7.695.
Conclusions: In the present study, we obtained favourable results of medialization thyroplasty as expressed by objective analysis of voice including GRABS score and acoustic analysis as well as maximum phonation time apart from traditional voice recording.
McGlashan JA. Evaluation of the voice. In: Watkinson JC, Clarke RW, eds. Scott-Brown's Otorhinolaryngology and Head and Neck Surgery. 8th Edition. CRC Press; 2018.
Rosen CA, Murry T. Nomenclature of voice disorders and vocal pathology. Otolaryngol Clin North Am. 2000;33(5):1035-46.
Dejonckere PH, Bradley P, Clemente P, Cornut G, Crevier-Buchman L, Friedrich G, et al. A basic protocol for functional assessment of voice pathology especially for investigating the efficacy of (Phonosurgical) treatments and evaluating new assessment techniques. Euro Arch Otorhinolaryngol 2001;258(2):77-82.
Webb AL, Garding PN. Optimizing outcome assessment of voice intervention. J Laryngol Otol. 2007;121:763-67.
Carding PN, Wilson JA. Measuring voice outcome; state of science review. J Laryngol Otol. 2009;123:823-9.
Kreiman J, Gerratt BR. Validity of rating scale measures of voice quality. J Acoust Soc Am. 1998;104(3):1598-608.
American speech language hearing Association (ASHA). Consensus Auditory Perceptual Evaluation of Voice (CAPEV). 2003.
Carding P, Carlson E, Epstein R, Mathieson L, Shewell C. Formal perceptual evaluation of voice quality in the United Kingdom. Logoped Phoniatar Vocol. 2000;25(3):133-8.
Mryan Y, Roy N, De Bodt M. Acoustic measurement of overall voice quality: a meta-analysis. J Acoust Soc Am. 2009;126(6):2619-34.
Carding PN, Steen IN, Webb A, Mackenzie K, Deary IJ, Wilson JA. The reliability and sensitivity to change of acoustic measures of voice quality. Clinical Otolaryngol Allied Sci. 2004;29:538-44.
Yumoto E, Gould WJ, Baer T. Harmonic to Noise ratio as an index of the degree of Hoarseness. J Acoust Soc Am. 1982;71:1544-9.
Hillman RE, Kobler JB. Aerodynamic measures of voice production. In: Kent RD, Ball MJ, eds. Voice quality measurement. San Diego: Singular Publishing Groups; 2000: 245-255.
Baken RJ, Orlikoff RF. Clinical measurements of speech and voice. 2nd ed. San Diego: Singular Thomson Learning; 2000.
Rosen CA, Lee AS, Osborne J. Development and validation of Voice Handicap index-10. Laryngoscope. 2004;114(9):1549-56.
Rosen CA, Murry T, Zinn A, Zullo T, Sonbolian M. Voice handicap index change following treatment of voice disorders. J Voice. 2000;14(4):619-23.
Wilson JA, Webb A, Carding PN. The voice symptom scale (VoiSS) and the vocal handicap index (VHI): a comparison of structure and content. Clin Otolaryngol. 2004;29:169-74.
Estes C, Sadoughi B, Mauer E. Laryngoscopic and Stroboscopic signs in the diagnosis of vocal fold paresis.Laryngoscope. 2017;127(9):1200-5.
Hochman II, Zeitels SM. Phonomicrosurgical management of vocal fold polyps: the subepithelial microflap resection technique. J Voice. 2000;14(1):112-8.
Arnold GE. Vocal rehabilitation of paralytic dysphonia: IX: technique of intracordal injection. Arch Otolaryngol. 1962;76:358-68.
Shaw GY, Szewczyk MA, Searle J, Woodroof J. Autologus fat injection into the vocal folds: technical consideration and long term follow up. Laryngoscope. 1997;107:177-86.
Tsuzuki T, Fukuda H, Fujioka T. Response of human larynx to Siliconee. Am J Otolaryngol. 1991;12(5):288-91.
Dedo HH, Urrea RD, Lawson L. Intracordal injection of Teflon in the treatment of 135 patients with dysphonia. Ann Otol. 1973;82:661-7.
Isshiki N, Okamura H, Ishikawa T. Thyroplasty type-1 (lateral compression) for dysphonia due to vocal cord paralysis or atrophy. Acta Otolaryngol. 1975;80:465-73.
Shindo M, Zarentsky L. Autologus fat injection for unilateral vocal fold paralysis. Ann otolrhinolaryngol. 1996;105:602-6.
Mohanty S et al. Gore-Tex medicalization thyroplasty in patients with unilateral vocal cord paralysis: an audit of 47 cases. Int J Phonosurg Laryngol. 2011;1(1):11-3.
Pal KS, Kaushal AK, Nagpure PS, Agarwal G. Etiopathological Study of 100 patients of hoarseness of voice: in a rural based hospital. Indian J Otolaryngol Head Neck Surg. 2014;66(1):40-5.
Baitha S. Clinical profile of hoarseness of voice. Indian J Otolaryngol Head Neck Surg. 2002;54(1):14-8.
Elnashar I, El-Anwar M, Amer H, Quriba A. Voice outcome after Gore-Tex medialization thyroplasty.. Int Arch Otorhinolaryngol. 2015;19:248-54
Chowdhury K, Saha S, Saha VP, Pal S, Chatterjee I. Pre and post-operative voice analysis after medialization thyroplasty in cases of unilateral vocal fold paralysis. Indian J Otolaryngol Head Neck Surg. 2013;65(4):354-7.
Berasategui I, García L. Unilateral vocal fold paralysis: quality of voice after speech therapy. InAnales del sistema sanitario de Navarra 2016;39(1):69-75.
Carroll TL, Rosen CA, Soose RJ. Vocal Cord paralysis. University of Pittsburgh Voice Center; Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine, 2010.
Clark A. 2014 compared voice handicap index-10 with voice handicap index in patients with voice disorders for qualifying patients perception of their voice handicap; 2014.
Watanabe K, Sato T, Honkura Y, Kawamoto-Hirano A, Kashima K, Katori Y. Characteristics of the voice handicap index for patients with unilateral vocal fold paralysis who underwent arytenoid adduction. J Voice. 2020;34(4):649-6.