Results of Fascial Augmentation in Unilateral Vocal Fold Paralysis

2002 ◽  
Vol 111 (6) ◽  
pp. 523-529 ◽  
Author(s):  
Petri Reijonen ◽  
Sari Lehikoinen-Söderlund ◽  
Heikki Rihkanen
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Inexpensive Method ◽  
Maximum Phonation Time ◽  
Perceptual Evaluation

The objective of this study was to evaluate the effects on voice quality of augmentation by injection of minced fascia in patients with unilateral vocal fold paralysis. Preoperative and postoperative voice samples from 14 patients (6 men and 8 women; mean age, 59 years) were analyzed by computerized acoustic analysis and blinded perceptual evaluation. Statistically significant improvements were seen in perturbation measurements (jitter and shimmer), noise-to-harmonics ratio, and maximum phonation time. A panel of evaluators rated 10 of the 14 postoperative voices as normal or near-normal. Injection laryngoplasty with minced fascia offers a new, effective, well-tolerated, and inexpensive method to medialize a paralyzed vocal fold. The graft seems to survive well, as indicated by good vocal results with a follow-up ranging from 5 to 32 months.

scholarly journals Using Innovative Acoustic Analysis to Predict the Postoperative Outcomes of Unilateral Vocal Fold Paralysis

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Yung-An Tsou ◽  
Yi-Wen Liu ◽  
Wen-Dien Chang ◽  
Wei-Chen Chen ◽  
Hsiang-Chun Ke ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Linear Prediction ◽  
Acoustic Analysis ◽  
Characteristic Curve ◽  
Voice Quality ◽  
Treatment Strategies ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Outcome Predictor ◽  
Laryngeal Framework Surgery

Objective.Autologous fat injection laryngoplasty is ineffective for some patients with iatrogenic vocal fold paralysis, and additional laryngeal framework surgery is often required. An acoustically measurable outcome predictor for lipoinjection laryngoplasty would assist phonosurgeons in formulating treatment strategies.Methods.Seventeen thyroid surgery patients with unilateral vocal fold paralysis participated in this study. All subjects underwent lipoinjection laryngoplasty to treat postsurgery vocal hoarseness. After treatment, patients were assigned to success and failure groups on the basis of voice improvement. Linear prediction analysis was used to construct a new voice quality indicator, the number of irregular peaks (NIrrP). It compared with the measures used in the Multi-Dimensional Voice Program (MDVP), such as jitter (frequency perturbation) and shimmer (perturbation of amplitude).Results.By comparing the [i] vowel produced by patients before the lipoinjection laryngoplasty (AUC = 0.98, 95% CI = 0.78–0.99), NIrrP was shown to be a more accurate predictor of long-term surgical outcomes than jitter (AUC = 0.73, 95% CI = 0.47–0.91) and shimmer (AUC = 0.63, 95% CI = 0.37–0.85), as identified by the receiver operating characteristic curve.Conclusions.NIrrP measured using the LP model could be a more accurate outcome predictor than the parameters used in the MDVP.

Impact of speech therapy on the improvement of voice quality in patients with unilateral vocal fold paralysis

2018 ◽  
Vol 7 (4) ◽  
pp. 1-7
Author(s):  
Anna Kuligowska ◽  
Barbara Jamróz ◽  
Joanna Chmielewska ◽  
Katarzyna Jędra ◽  
Tomasz Czernicki ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Speech Therapy ◽  
Acoustic Analysis ◽  
Vocal Tract ◽  
Voice Quality ◽  
Maximum Phonation Time ◽  
Before And After ◽  
Vocal Fold Palsy ◽  
The Voice

Aim of study: Evaluation of the speech therapy on voice quality in patients with unilateral vocal fold palsy. Material and methods: The study group included 11 patients, 8 women and 3 men, in age between 16 to 72 years, with unilateral vocal fold palsy, diagnosed in ENT Department of Warsaw Medical University between 2017-2018. Each person completed questionnaires: the voice disability self-assessment scale (VHI), the voice-based quality of life (VRQoL) scale, the vocal tract discomfort scale (VTD). All questionnaires were completed twice, before and after the voice therapy. In addition, the acoustic analysis of the voice, the assessment of the maximum phonation time and the breathing tract were performed twice in each patient. Each of the patients had a voice rehabilitation consisting of a series of 10 meetings. Results: Statistical analysis of the results of maximum phonation time, the self-assessment of voice disability, the quality of life depending on the voice, discomfort of the vocal tract voice acoustic analysis showed statistically significant differences in the results before and after rehabilitation (p <0.005). In addition, the improvement of the respiratory tract was observed in the majority of patients. Conclusions: Speech therapy significantly affects the voice quality of patients with unilateral laryngeal nerve palsy.

Medialization thyroplasty in glottis insufficiency due to unilateral vocal fold paralysis and after laser cordectomies – preliminary report

2017 ◽  
Vol 71 (1) ◽  
pp. 22-29
Author(s):  
Anna Rzepakowska ◽  
Ewa Osuch-Wójcikiewicz ◽  
Ewelina Sielska-Badurek ◽  
Kazimierz Niemczyk
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Standard Procedure ◽  
Thyroid Cartilage ◽  
Voice Quality ◽  
Type I ◽  
Vocal Fold Paresis ◽  
Maximum Phonation Time ◽  
Perceptual Evaluation ◽  
Medialization Thyroplasty

Medialization thyroplasty (type I) is surgical procedure performed on the thyroid cartilage. The major indication for this surgery is significant glottis insufficiency due to unilateral vocal fold paresis. However the proce¬dure is also performed after vocal fold resections during cordectomy. The aim: The evaluation of voice results in patients after medialisation throplasty. Material and methods: In Otolaryngology Department of Medical University of Warsaw there were performed so far 8 thyroplasty procedures under local anaesthesia with implantation of medical silicon protesis. 6 patients had unilat¬eral vocal fold paresis and the rest two underwent in the past laser cordectomy due to T1a vocal carcinoma. Results: There were no complications during and post the surgery. The follow up examination in 1st , 3rd, 6th i 12th months postoperatively revealed for all patients significant improvement of glottal closure in laryngeal videostrobos¬copy. The voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shim¬mer, NHR) in both patients groups. However the rate of improvement was much more significant in group with uni¬lateral vocal fold paresis. In all patients the maximum phonation time (MPT) increased. The self-evaluation of voice quality with Voice Handicap Index questionnaire confirmed also individual improvement. Conclusions: The speech rehabilitations is not successful in each patient with glottis insufficiency. The medialisation thyroplasty remains the standard procedure for permanent improvement of voice quality in those cases.

Implications of Synkinesis in Unilateral Vocal Fold Paralysis

2017 ◽  
Vol 157 (6) ◽  
pp. 1017-1024 ◽  
Author(s):  
Yu-Cheng Pei ◽  
Wei-Han Chang ◽  
Hsiu-Feng Chuang ◽  
Chia-Fen Chang ◽  
Tuan-Jen Fang
Keyword(s):  
Quality Of Life ◽  
Vocal Fold ◽  
Acoustic Analysis ◽  
Medical Center ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Cricothyroid Muscle ◽  
Related Quality ◽  
The Impact

Objectives In patients with unilateral vocal fold paralysis (UVFP), laryngeal electromyography (LEMG) occasionally observes synkinesis in laryngeal muscles, a condition that could impair vocal fold mobility and voice control. This study aims to evaluate the impact of synkinesis on UVFP patients. Study Design A retrospective case-control study. Setting Medical center. Subjects and Methods Patients with UVFP onset >6 months were recruited (N = 104). The outcome measurements included LEMG, quantitative LEMG analysis of thyroarytenoid–lateral cricoarytenoid (TA-LCA) muscle complex, glottal gap measured by videolaryngostroboscopy, voice-related quality of life, and voice acoustic analysis. Results According to the LEMG analysis, 8 patients (8%) had synkinesis, and 96 (92%) did not. In the synkinesis group, TA-LCA turn frequency in the lesioned side was comparable to that in the healthy side ( P = .52). Patients in the synkinesis group had higher TA-LCA turn frequency ( P = .001), higher probability of cricothyroid muscle dysfunction ( P = .04), and better voice-related quality of life ( P = .01) but objective voice outcomes comparable to those in the nonsynkinesis group. Conclusions Patients with synkinesis will have near-complete restoration in TA-LCA turn frequency but still experience voice impairment, a finding that is compatible with the mechanism of aberrant reinnervation. However, patients with synkinesis have better disease-related quality of life than do those without synkinesis.

Novel Approach of Medialization Thyroplasty with Arytenoid Adduction Performed under General Anesthesia with a Laryngeal Mask

2011 ◽  
Vol 146 (2) ◽  
pp. 266-271 ◽  
Author(s):  
Nicholas W. Stow ◽  
Jennifer W. Lee ◽  
Ian E. Cole
Keyword(s):  
Vocal Fold ◽  
Case Series ◽  
Vocal Fold Paralysis ◽  
Laryngeal Mask ◽  
Unilateral Vocal Fold Paralysis ◽  
Maximum Phonation Time ◽  
Arytenoid Adduction ◽  
Medialization Thyroplasty ◽  
The Voice

Objective. To objectively assess the voice outcomes of patients with unilateral vocal fold paralysis treated with medialization thyroplasty and arytenoid adduction suture. Study Design. Case series of patients who underwent medialization thyroplasty and arytenoid adduction suture. Preoperative and postoperative voice testing was performed and the data were compared by statistical analysis. Setting. Tertiary referral teaching hospital in Sydney, Australia. Subjects. All patients had a unilateral vocal fold paralysis, with a large posterior glottic gap and vocal symptoms affecting their quality of life. Methods. Thirteen patients with a diagnosis of a unilateral vocal fold paralysis with a large posterior glottic gap, vocal symptoms, and total denervation of the vocal fold underwent medialization thyroplasty and arytenoid adduction suture. The surgery was performed in a novel method under a general anesthetic using a laryngeal mask and with direct intraoperative endoscopic feedback. Preoperative and postoperative measures of voice performance were compared, including acoustic analysis (fundamental frequency, speech intensity against quiet and loud background noise, speech rate) and aerodynamic assessment (airflow, maximum phonation time). Results. Medialization thyroplasty with arytenoid adduction suture significantly improved aerodynamic assessment and phonation duration for both male and female subjects overall. There were 2 of 13 treatment failures. Median follow-up time was 6 months. Conclusion. Preliminary results indicate that in selected patients with vocal fold paralysis, medialization thyroplasty with arytenoid adduction suture leads to significant improvements in objective voice measures. Longer follow-up data are required to further quantify the voice outcomes after this procedure.

scholarly journals Respiratory and voice outcomes of office-based injection laryngoplasty in patients with unilateral vocal fold paralysis

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Asser Elsaeed ◽  
Omayma Afsah ◽  
Waleed Moneir ◽  
Tamer Elhadidy ◽  
Tamer Abou-Elsaad
Keyword(s):  
Vocal Fold ◽  
Pulmonary Function Tests ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Post Injection ◽  
Injection Laryngoplasty ◽  
Unilateral Vocal Fold Paralysis ◽  
Maximum Phonation Time ◽  
Significant Difference ◽  
Perceptual Assessment

Abstract Background Injection laryngoplasty is a surgical procedure used in management of glottal insufficiency. The objective of this study was to assess respiratory and voice outcomes of office-based injection laryngoplasty in patients with unilateral vocal fold paralysis (UVFP). Ten patients underwent office-based injection via transcutaneous approach using Radiesse or hyaluronic acid. Auditory perceptual assessment (APA), voice handicap index (VHI), size of the glottic gap, acoustic parameters (jitter, shimmer, and harmonic to noise ratio), maximum phonation time (MPT), stroboscopic evaluation, pulmonary function tests (PFTs), and videofluoroscopic evaluation of swallowing were done pre-injection, 1 week and 3 months post-injection. Results Subjective and objective voice outcomes, in addition to laryngostroboscopic parameters improved after injection. Non-significant difference was found between pre- and post-injection results of the PFTs. Conclusions Office-based injection laryngoplasty is a safe and effective method for treating UVFP. Patients with glottic gap (< 1–3 mm) are perfect candidates for such procedure. Injection laryngoplasty improves patients’ voice quality and does not impair respiration.

Acoustic Characteristics of Post-Thyroplasty Patients

1992 ◽  
Vol 107 (4) ◽  
pp. 558-563 ◽  
Author(s):  
Gary R. Lablance ◽  
Michael D. Maves
Keyword(s):  
Fundamental Frequency ◽  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Type I ◽  
Unilateral Vocal Fold Paralysis ◽  
Pitch Range ◽  
Acoustic Characteristics ◽  
Maximum Phonation Time ◽  
Frequency Changes

This study investigated changes in voice quality after thyroplasty type I in eight adults with unilateral vocal fold paralysis. A silicone rubber implant was inserted through a window in the thyroid ala and placed between the inner and outer perichondrium to externally medialize the abducted vocal fold. Measures of fundamental frequency (vocal pitch), pitch range, maximum phonation time, s/z ratio, pitch perturbation (vocal jitter), and amplitude perturbation (vocal shimmer) were made 1 to 2 weeks preoperatively and 1 month postoperatively. Postoperative voice quality was characterized by an improved pitch range, phonation time, s/z ratio, and pitch and amplitude perturbation. No change was noted in fundamental frequency. Changes in postoperative voice quality were unrelated to the subjects' preoperative age, sex, etiology, and duration of the paralysis.

Autologous Fat Injection for Unilateral Vocal Fold Paralysis

1996 ◽  
Vol 105 (8) ◽  
pp. 602-606 ◽  
Author(s):  
Maisie L. Shindo ◽  
Lauren S. Zaretsky ◽  
Dale H. Rice
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Fat Injection ◽  
Autologous Fat ◽  
The Voice ◽  
Fat Volume

This study evaluates the efficacy of autologous fat injection for medialization of the paralyzed vocal fold. In 21 patients with unilateral vocal fold paralysis, autologous abdominal fat was injected into the thyroarytenoid muscle to achieve medialization. All patients were followed up with serial videolaryngoscopy and voice evaluation. At 2 months' follow-up, the voice was judged to be excellent in 10 patients, slightly breathy but significantly better than the preoperative voice in 6 patients, and markedly breathy in 4 patients. At 3 to 4 months' follow-up, of the 10 patients with excellent results, 5 maintained an excellent voice, 3 had developed slight breathiness, and 1 had developed severe breathiness. Long-term (6 to 12 months) results were available in 11 patients, and all of them maintained the same voice quality that was noted during the 3 to 4 months' examination. Magnetic resonance imaging of the larynx was obtained in 7 patients at intervals ranging from 1 to 7 months and compared to the baseline scan obtained at 1 week postoperative to assess the amount of fat remaining in the muscle. The images showed fat volume to persist, but a decrease in the fat signal was observed over time. The results suggest that the duration of medialization with autologous fat is variable, but appears to last at least 2 to 3 months. This loss of volume after 3 months seems to be due to absorption of the fat and possibly muscle atrophy. Autologous fat injection is relatively safe and easy to perform, and is an ideal method of temporary vocal fold medialization in patients in whom return of vocal fold function is expected.

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