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Yang ZM, Malka R, Erwin DZ, Postma G. Airway and Voice Outcomes After Thyroarytenoid Myomectomy for Bilateral Vocal Fold Immobility. Laryngoscope 2024. [PMID: 38807469 DOI: 10.1002/lary.31545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Type 4 posterior glottic stenosis and bilateral vocal fold paralysis are clinically challenging causes of bilateral vocal fold immobility (BVFI) that result in glottic airway obstruction. Established procedures for BVFI typically worsen dysphonia. We hypothesize the use of thyroarytenoid myomectomy (TAM) in the setting of BVFI will improve dyspnea with decreased detriment to voice. METHODS Eleven unilateral TAM procedures were performed between April 2021 and June 2023 at a single institution. Pre- and postoperative patient reported outcomes were compared. Representative images of maximal glottic opening were analyzed in ImageJ to calculate ipsilateral bowing index (BI), total BI, maximum glottic surface area (MGSA), and maximum opening angle (MOA). Statistical comparisons were performed with paired t-tests when normality was confirmed with Shapiro-Wilk test and otherwise with Wilcoxon signed-rank tests, with threshold for significance of α = 0.05. Interrater reliability for objective glottal measures was compared with intraclass correlation coefficient (ICC). RESULTS Dyspnea Index improved from mean (standard error) of 24.1 (3.8) to 9.1 (3.3), p = 0.004. Voice Handicap Index-10 improved from 20.0 (4) to 10.3 (3.8), p = 0.011. Glottal Function Index improved from 9.6 (1.4) to 6.3 (1.3), p = 0.017. There was no significant difference in ipsilateral BI, total BI, MOA, and median MGSA. There was good to excellent ICCs for all comparisons (0.83-0.95). CONCLUSIONS TAM demonstrated significant improvement in symptoms from BVFI while not significantly altering glottal structure. These data suggest TAM improves dyspnea in patients with BVFI without significantly impairing voice. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Zao M Yang
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas, U.S.A
| | - Ronit Malka
- Department of Otolaryngology-Head & Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, U.S.A
| | - Dylan Z Erwin
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas, U.S.A
| | - Gregory Postma
- Department of Otolaryngology-Head & Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
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Syamal MN, Kincaid H, Sutter A. Examining readmissions following outpatient microlaryngeal surgery. Laryngoscope Investig Otolaryngol 2023; 8:946-952. [PMID: 37621263 PMCID: PMC10446258 DOI: 10.1002/lio2.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 08/26/2023] Open
Abstract
Objective The objective of this study was to examine readmissions following microlaryngeal surgery. It was hypothesized that airway surgical procedures would have higher rates of readmission. Design Retrospective review. Methods Outpatient microlaryngeal surgeries from May 1, 2018 to November 27, 2022 were reviewed. Readmissions related to the original surgery within a 30-day postoperative period were examined. Patient demographics, body mass index, American Society of Anesthesiologist class, comorbidities, type of surgery, ventilation techniques, and operative times were examined and compared. Results Out of 480 procedures analyzed, 19 (4.0%) resulted in a readmission, 9 (1.9%) of which were for glottic stenosis management. Undergoing an airway procedure was significantly associated with a readmission (p = .002) and increased the odds of readmission by 5.99 (95% confidence interval [CI]: 2.22-16.16, p < .001). Current/former smoking status increased the odds of readmission by 4.50 (95% CI: 1.33-15.19, p = .016). Each additional minute of operating time increased the odds of readmission by 1.03 (95% CI: 1.00-1.05, p = .04). Conclusion Readmissions from microlaryngeal surgery are seldom reported but nonetheless occur. Identifying factors that may place a procedure at risk for readmission can help improve surgical quality of care. Level of Evidence 4.
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Affiliation(s)
- Mausumi N. Syamal
- Division of Otolaryngology‐Head and Neck SurgeryLehigh Valley Health NetworkAllentownPennsylvaniaUSA
- Morsani School of MedicineUniversity of South FloridaTampaFloridaUSA
| | - Hope Kincaid
- Lehigh Valley HealthNetwork Office of Research and InnovationAllentownPennsylvaniaUSA
| | - Alison Sutter
- Lehigh Valley HealthNetwork Office of Research and InnovationAllentownPennsylvaniaUSA
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Robotti C, Mozzanica F, Barillari MR, Bono M, Cacioppo G, Dimattia F, Gitto M, Rocca S, Schindler A. Treatment of relapsing functional and organic dysphonia: a narrative literature review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S84-S94. [PMID: 37698105 PMCID: PMC10159638 DOI: 10.14639/0392-100x-suppl.1-43-2023-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 09/13/2023]
Abstract
Information about failure and relapses is critical in deciding whether and how to treat a given condition, as well as during patient counselling before therapy. This paper aims to perform a non-systematic review of relapses and failure of dysphonia treatment in the adult population. Studies on failure and relapses after treatment of benign vocal fold lesions, functional dysphonia and neurogenic dysphonia were analysed. The frequency and the duration of follow-up were heterogeneous, and the management of relapses was reported in only a portion of the studies. Relapses after surgical treatment of benign vocal fold lesions ranged between 1% and 58% of cases, and their management was mainly surgical. Rates of relapse after voice therapy for functional dysphonia and spasmodic dysphonia were 12%-88% and 8%-63%, respectively. Rates of relapse after surgical treatment for unilateral and bilateral vocal fold paralysis were 10%-39% and 6%-25%, respectively; treatment was mainly represented by surgical revision. In conclusion, failure and relapses of functional and organic dysphonias after therapy are not rare, but treatment modalities are seldomly reported. The data from this non-systematic review stresses the need for further research in this area.
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Affiliation(s)
- Carlo Robotti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesco Mozzanica
- Department of Otorhinolaryngology, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Maria Rosaria Barillari
- Department of Mental and Physical Health and Preventive Medicine, University of “Luigi Vanvitelli”, Naples, Italy
| | - Marcella Bono
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giancarlo Cacioppo
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Francesca Dimattia
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Marco Gitto
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Sara Rocca
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Talmor G, Tseng C, Nguyen B, Badash I, Lovinescu CD, Benson B, Kaye R. Unilateral Cordotomy: A Systematic Review of Efficacy and Outcomes. Laryngoscope 2023; 133:6-14. [PMID: 35253905 DOI: 10.1002/lary.30097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Glottic obstruction may arise secondary to bilateral vocal fold immobility (BVFI). Treatment options include a tracheostomy to bypass the site of obstruction as well as unilateral transverse cordotomy to alleviate the obstruction. The objective of this review is to determine the efficacy, adverse event profile, and long-term outcomes, including the need for tracheostomy, in patients undergoing unilateral cordotomy. METHODS The Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for this systematic review. A literature search of unilateral cordotomy was performed by searching PubMed, Cochrane Library, and Embase. Articles presenting cases of BVFI treated with unilateral cordotomy were included. Review articles, animal studies, non-English-language articles, and abstracts were excluded. Articles presenting cases of bilateral cordotomy or cordotomy with arytenoidectomy were excluded. RESULTS We identified 14 studies and 291 patients undergoing unilateral cordotomy. Sixty-eight patients had a prior tracheostomy in place at the time of cordotomy. The most common post-operative complication was granulation tissue formation (n = 39). Thirty-one patients developed glottic edema with subsequent dyspnea. Three patients developed scarring of the primary cordotomy site with the return to an obstructed airway. Nine patients required a post-cordotomy tracheostomy due to these complications. Five patients required a long-term tracheostomy and were unable to be decannulated. CONCLUSION Unilateral cordotomy is an effective treatment for glottic obstruction with high post-operative decannulation rates. Adverse events including worsening glottic obstruction are uncommon, although edema and granulation tissue may develop in the post-operative period and necessitate close post-operative monitoring. Laryngoscope, 133:6-14, 2023.
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Affiliation(s)
- Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Christopher Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Brandon Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Ido Badash
- Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Corina Din Lovinescu
- New York Center for Voice and Swallowing Disorders, Mount Sinai St. Luke's Roosevelt, New York, New York, U.S.A
| | - Brian Benson
- Department of Otolaryngology-Head and Neck Surgery, Hackensack University Medical Center, Hackensack, New Jersey, U.S.A
| | - Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, U.S.A
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Benninger MS, Syamal M, Gau VL, Bryson PC, Hrelec C. Coblation Cordotomy for the Management of Bilateral Vocal Fold Immobility. J Voice 2022:S0892-1997(22)00274-0. [PMID: 36270920 DOI: 10.1016/j.jvoice.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Bilateral vocal fold immobility (BVFI) has an impact on both the voice and breathing. Many procedures have been developed to manage BVFI including the use of a coblator to perform a unilateral posterior cordotomy. This study evaluated the use of unilateral coblator cordotomy for BVFI. STUDY DESIGN Retrospective chart review. METHODS Ninety-four patients having undergone coblation cordotomies for BVFI performed by surgeons at two different institutions. Parameters evaluated were etiology of BVFI, prior tracheotomy, the number of revision procedures, postoperative decannulations, breathing outcomes as measured by Dyspnea Index, and voice outcomes as measured by the Voice Handicap Index. RESULTS The main causes of immobility were thyroidectomy and prolonged endotracheal intubation. Twenty-one procedures were performed in patients who had a tracheotomy already in place, two required concurrent tracheotomy with cordotomy, and two underwent tracheotomy some time after cordotomy. The mean follow up was 16 months (1-38 months). Of the 25 patients who had a tracheotomy tube placed before or during the course of their care, we were unable to decannulate four of them after initial or revision cordotomy. Twenty of our 94 patients required a secondary revision unilateral cordotomy, usually on the previously un-operated vocal fold. This was more common in bilateral fixation than in paralysis. In 44 patients where Voice Handicap Index data was known both pre- and postoperatively, the median VHI scores improved from 62.2 to 37.4, while the VHI worsened in only four patients. Eight patients had a Dyspnea index performed both pre- and post-operatively and the median score dropped from 18.3 to 12.5. CONCLUSION Coblation cordotomy is a reasonable option for vocal fold lateralization in BVFI. In our study, this method allowed for decannulation in 21 of 25 patients who had a tracheotomy. The initial coblator cordotomy was sufficient for the majority of patients, with 22% (20/94) requiring a revision procedure. Interestingly, our study also showed promising voice outcomes with improvements in VHI in all but four patients.
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Affiliation(s)
| | - Mausumi Syamal
- Department of Otolaryngology-Head and Neck Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Victoria L Gau
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio.
| | - Paul C Bryson
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio
| | - Candace Hrelec
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio
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Karkos PD, Stavrakas M, Koskinas I. Factors Affecting Success of Laser Posterior Trasverse Cordotomy. Laryngoscope 2020; 131:E525. [PMID: 33280119 DOI: 10.1002/lary.29177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Petros D Karkos
- 1st Department of Otolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marios Stavrakas
- 1st Department of Otolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Koskinas
- 1st Department of Otolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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