TY - JOUR
T1 - Arytenoid adduction with medialization laryngoplasty versus injection or medialization laryngoplasty
T2 - The role of the arytenoidopexy
AU - Mortensen, Melissa
AU - Carroll, Linda
AU - Woo, Peak
PY - 2009/4
Y1 - 2009/4
N2 - Objectives/Hypothesis: There continues to be controversy about the added role of arytenoid adduction (AA) in the rehabilitation of unilateral vocal cord paralysis (UVCP). Some authors feel that the added morbidity of AA is not warranted in UVCP rehabilitation. Objective analysis of acoustic and aerodynamic measures were performed before and after surgery to try to resolve this controversy. Methods: This is an institutional review boardapproved retrospective study of 85 patients with UVCP undergoing surgical rehabilitation by injection laryngoplasty (n=45), medialization laryngoplasty (n=14), or medialization laryngoplasty with arytenoid adduction (n=26). Acoustic and aerodynamic parameters were studied before and after surgery. The medialization laryngoplasty (ML) group (medialization alone, injection laryngoplasty ML/IL) data were compared to the AA-ML group using a paired t test for the individual measures and analysis of variance (ANOVA) for the multivariate analysis of acoustic and aerodynamic measures. Results: In all treatment arms there were statistically significant improvements in all acoustic and aerodynamic measures after intervention (P <.05). For ML and IL, the mean difference between preoperative from postoperative jitter was 1.504%, shimmer 3.265%, noise to harmonic ratio (NHR) 0.036, mean phonation time 4.523 seconds, transglottic flow 0.130 L/s, and subglottic pressure 0.616 cm H2O. For AA-ML the mean difference between preoperative and postoperative jitter was 2.431%, shimmer 6.068%, NHR 0.082, mean phonation time 6.74 seconds, flow 0.181 L/s, and subglottic pressure 0.611 cm H2. Preoperatively, the average phonatory function of the AA-ML group was worse than the ML group. Comparison between the two treatment arms, individual acoustic and aerodynamic measures, were not different (paired t test, P <.05). However, mulitvariate analysis (ANOVA, P <.05) of acoustic and aerodynamic measures, showed a statistically significant difference between the two groups. The degree of change was significantly better in the AA-ML group. Conclusions: AA-ML and IL/ML improve phonatory function, but not to normal. We were unable to demonstrate a statistical difference between groups using a single measure, but using mutlivariate analysis, there is a statistical significance between the groups. AA-ML patients had worse preoperative function and had better postoperative function. When clinically indicated, AA-ML procedure does appear to correct the physiology of the incompetent larynx better than ML alone.
AB - Objectives/Hypothesis: There continues to be controversy about the added role of arytenoid adduction (AA) in the rehabilitation of unilateral vocal cord paralysis (UVCP). Some authors feel that the added morbidity of AA is not warranted in UVCP rehabilitation. Objective analysis of acoustic and aerodynamic measures were performed before and after surgery to try to resolve this controversy. Methods: This is an institutional review boardapproved retrospective study of 85 patients with UVCP undergoing surgical rehabilitation by injection laryngoplasty (n=45), medialization laryngoplasty (n=14), or medialization laryngoplasty with arytenoid adduction (n=26). Acoustic and aerodynamic parameters were studied before and after surgery. The medialization laryngoplasty (ML) group (medialization alone, injection laryngoplasty ML/IL) data were compared to the AA-ML group using a paired t test for the individual measures and analysis of variance (ANOVA) for the multivariate analysis of acoustic and aerodynamic measures. Results: In all treatment arms there were statistically significant improvements in all acoustic and aerodynamic measures after intervention (P <.05). For ML and IL, the mean difference between preoperative from postoperative jitter was 1.504%, shimmer 3.265%, noise to harmonic ratio (NHR) 0.036, mean phonation time 4.523 seconds, transglottic flow 0.130 L/s, and subglottic pressure 0.616 cm H2O. For AA-ML the mean difference between preoperative and postoperative jitter was 2.431%, shimmer 6.068%, NHR 0.082, mean phonation time 6.74 seconds, flow 0.181 L/s, and subglottic pressure 0.611 cm H2. Preoperatively, the average phonatory function of the AA-ML group was worse than the ML group. Comparison between the two treatment arms, individual acoustic and aerodynamic measures, were not different (paired t test, P <.05). However, mulitvariate analysis (ANOVA, P <.05) of acoustic and aerodynamic measures, showed a statistically significant difference between the two groups. The degree of change was significantly better in the AA-ML group. Conclusions: AA-ML and IL/ML improve phonatory function, but not to normal. We were unable to demonstrate a statistical difference between groups using a single measure, but using mutlivariate analysis, there is a statistical significance between the groups. AA-ML patients had worse preoperative function and had better postoperative function. When clinically indicated, AA-ML procedure does appear to correct the physiology of the incompetent larynx better than ML alone.
KW - Arytenoid adduction
KW - Laryngoplasty
KW - Medialization
KW - Unilateral vocal cord paralysis
UR - http://www.scopus.com/inward/record.url?scp=65249186666&partnerID=8YFLogxK
U2 - 10.1002/lary.20171
DO - 10.1002/lary.20171
M3 - Article
C2 - 19263407
AN - SCOPUS:65249186666
SN - 0023-852X
VL - 119
SP - 827
EP - 831
JO - Laryngoscope
JF - Laryngoscope
IS - 4
ER -