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Brake DA, Patel RR, Risser RM, Ambrose G, Anthony BP. Treatment Outcomes of Type 1 Thyroplasty Using Gore-Tex® Following Injection Laryngoplasty. Ann Otol Rhinol Laryngol 2022:34894221120127. [PMID: 36168678 DOI: 10.1177/00034894221120127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare voice-related outcomes of type 1 thyroplasty using Gore-Tex® between patients with and without augmentation injection laryngoplasty (IL) prior to surgery. METHODS Forty-five patients who underwent Gore-Tex® thyroplasty at a single institution by a single surgeon between November 2016 and February 2019 were identified as those who previously had IL (n = 20) and those without IL (n = 25). Pre- and post-operative voice-related primary outcomes were evaluated using the GRBAS, and CAPE-V auditory-perceptual rating scales and secondary outcome were evaluated using the VRQOL. Pre- and post-operative voice samples were blinded, randomized, and analyzed by 3 voice-specialized speech pathologists to obtain CAPE-V scores. The VRQOL and GRBAS scores were obtained from retrospective chart review. Student's t test with a paired one-tailed distribution was used for comparisons within groups and 2-sample equal variance for comparisons between groups. Intraclass correlation coefficient determined interrater agreement. RESULTS GRBAS, and VRQOL significantly improved post Gore-Tex® thyroplasty. There was no difference in improvement between patients who received pre-surgery IL and those who did not in either GRBAS or VRQOL scores, but CAPE-V showed significant improvement in the IL group. A strongly positive correlation was demonstrated between the severity of CAPE-V pre-op score and the overall improvement following surgery for both groups combined. CONCLUSION Patients with vocal fold paralysis have a significantly better voice after Gore-Tex® thyroplasty by self-report (VRQOL) and assessment by trained voice professionals (GRBAS). Having IL prior to surgery does not adversely affect later surgical outcomes. This paper represents one of the largest analyses of voice quality outcomes of Gore-Tex® thyroplasty using validated patient scales and randomized blinded analyses.
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Affiliation(s)
- Daniela A Brake
- Department of Otolaryngology Head & Neck Surgery, Indiana University Health Voice Center, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Otolaryngology Head & Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Rita R Patel
- Department of Otolaryngology Head & Neck Surgery, Indiana University Health Voice Center, Indiana University School of Medicine, Indianapolis, IN, USA.,Speech, Language and Hearing Sciences, Indiana University Voice Center, Indiana University, Indianapolis, IN, USA
| | - Rebecca M Risser
- Department of Otolaryngology Head & Neck Surgery, Indiana University Health Voice Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gabrielle Ambrose
- Department of Otolaryngology Head & Neck Surgery, Indiana University Health Voice Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin P Anthony
- Department of Otolaryngology Head & Neck Surgery, Indiana University Health Voice Center, Indiana University School of Medicine, Indianapolis, IN, USA
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2
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Gray R, Misono S. Patient-Centered Care in Vocal Fold Paralysis: What Really Matters? CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Orbelo DM, Ekbom DC, Van Houten HK, Bayan SL, Balakrishnan K. Speech Pathology Utilization and Stroboscopy Before and After Adult Medialization Laryngoplasty. J Voice 2020; 36:423-433. [PMID: 32690345 DOI: 10.1016/j.jvoice.2020.06.024] [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: 04/07/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evaluation of trends and utilization of speech-language-pathology (SLP) services, including stroboscopy, before and after medialization laryngoplasty (ML) over 11 years. METHODS Retrospective national US database study conducted using OptumLabs Data Warehouse. Study cohort included patients (age ≥18 years) who underwent ML between January 2007 and December 2016. Primary outcomes were rates of SLP visits in the 12 months before and 12 months after ML. Linear regression analysis was performed assessing for trends utilization across years. Secondary outcomes were predictors of utilization After-ML using multivariable logistic regression. RESULTS 1114 patients met criteria. Services, including stroboscopy, were utilized by 774 (69%) Before-ML and 697 (63%) After-ML. SLP services, excluding stroboscopy, were utilized by 512 (46%) Before-ML and 478 (43%) After-ML. Vocal cord paralysis was the most common diagnosis, 945 (84.8%) patients. Other service billed were stroboscopy, [Before-ML 676 (60.7%); After-ML 567 (50.9%)], voice evaluation [Before-ML 431(38.7%); After-ML 366 (32.9%)], voice therapy [Before-ML 309 (27.7%); After-ML 339 (30.4%)], laryngeal function studies, [Before-ML 175 (15.7%); After-ML 164 (14.7%)], swallow evaluations [Before-ML 150 (13.5%); After-ML 90 (8.1%)], and swallow therapy [Before-ML 53 (4.8%); After-ML 47 (4.2%)]. SLP utilization Before-ML predicted SLP utilization After-ML [Odds Ratio (95% Confidence Interval): 9.31 (6.78, 12.77)]. Nearly half (49%) of visits occurred in the 6 months around ML. Of those who had voice therapy, the majority (73.7%) had a total of 1 to 5 sessions. CONCLUSION Based on this retrospective US national database study, SLP services and stroboscopy are a complementary component of assessment and treatment of patients who undergo ML with the majority of services occurring in the 3 months before and after ML. Future work would benefit from outcome data.
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Affiliation(s)
- Diana M Orbelo
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Dale C Ekbom
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Holly K Van Houten
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MNinnesota; OptumLabs, Cambridge, Massachusetts
| | - Semirra L Bayan
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karthik Balakrishnan
- Department of Otolaryngology - Head & Neck Surgery, Stanford University, Palo Alto, California
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Abu-Ghanem S, Rudy S, Deane S, Tsai SW, Shih LC, Damrose EJ, Sung CK. Early Injection Laryngoplasty After Surgery: 30 Cases and Proposed Aspiration Assessment Protocol. J Voice 2020; 34:121-126. [DOI: 10.1016/j.jvoice.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
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5
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Tsai MS, Yang YH, Liu CY, Lin MH, Chang GH, Tsai YT, Li HY, Tsai YH, Hsu CM. Unilateral Vocal Fold Paralysis and Risk of Pneumonia: A Nationwide Population-Based Cohort Study. Otolaryngol Head Neck Surg 2018; 158:896-903. [PMID: 29405850 DOI: 10.1177/0194599818756285] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To investigate pneumonia risk among patients with unilateral vocal fold paralysis (UVFP). Study Design Retrospective population-based cohort study. Setting This study used data from the National Health Insurance Research Database of Taiwan, a nationwide population-based database. Subjects and Methods A total of 419 patients newly diagnosed with UVFP between January 1, 1997, and December 31, 2013, were identified from the Longitudinal Health Insurance Database 2000, a nationally representative database of 1 million randomly selected patients. Moreover, 1676 patients without UVFP were matched to patients with UVFP at a 1:4 ratio based on age, sex, socioeconomic status, urbanization level, and site-specific cancers. Patients were followed up until death or the end of the study period (December 31, 2013). The primary outcome was the occurrence of pneumonia. Results The cumulative incidence of pneumonia was significantly higher for patients with UVFP than those without UFVP ( P < .001). The adjusted Cox proportional hazard model showed that UVFP was significantly associated with a higher incidence of pneumonia (hazard ratio, 1.97; 95% CI, 1.35-2.86; P < .001). Subgroup analyses demonstrated that UVFP was an independent risk factor of pneumonia for 4 subgroups: young (18-50 years), older (≥51 years), male, and cancer. Conclusion This is the first nationwide population-based cohort study to investigate the association between UVFP and pneumonia. The findings indicate that UVFP is an independent risk factor of pneumonia. Given the study results, physicians should be aware of the potential for pneumonia occurrence following UVFP.
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Affiliation(s)
- Ming-Shao Tsai
- 1 Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,2 Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- 2 Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.,3 Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.,4 Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,5 School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yen Liu
- 2 Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-Hung Lin
- 2 Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- 1 Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- 1 Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hsueh-Yu Li
- 6 Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,7 Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Huang Tsai
- 8 Division of Pulmonary and Critical Care Medicine, Department of Respiratory Care, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,9 Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Ming Hsu
- 1 Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,5 School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,10 Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Dion GR, Fritz MA, Teng SE, Marcus S, Fang Y, Branski RC, Amin MR. Impact of vocal fold augmentation and laryngoplasty on dyspnea in patients with glottal incompetence. Laryngoscope 2017; 128:427-429. [DOI: 10.1002/lary.26850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/13/2017] [Accepted: 07/24/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Gregory R. Dion
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Mark A. Fritz
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Stephanie E. Teng
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Sonya Marcus
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Yixin Fang
- Department of Population Health; New York University School of Medicine; New York New York U.S.A
| | - Ryan C. Branski
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Milan R. Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
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Allen J, Belafsky PC. Gastroesophageal Reflux Disease, Globus, and Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Cates DJ, Venkatesan NN, Strong B, Kuhn MA, Belafsky PC. Effect of Vocal Fold Medialization on Dysphagia in Patients with Unilateral Vocal Fold Immobility. Otolaryngol Head Neck Surg 2016; 155:454-7. [PMID: 27165683 DOI: 10.1177/0194599816645765] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The effect of vocal fold medialization (VFM) on vocal improvement in persons with unilateral vocal fold immobility (UVFI) is well established. The effect of VFM on the symptom of dysphagia is uncertain. The purpose of this study is to evaluate dysphagia symptoms in patients with UVFI pre- and post-VFM. STUDY DESIGN Case series with chart review. SETTING Academic tertiary care medical center. SUBJECTS AND METHODS The charts of 44 persons with UVFI who underwent VFM between June 1, 2013, and December 31, 2014, were abstracted from a prospectively maintained database at the University of California, Davis, Voice and Swallowing Center. Patient demographics, indications, and type of surgical procedure were recorded. Self-reported swallowing impairment was assessed with the validated 10-item Eating Assessment Tool (EAT-10) before and after surgery. A paired samples t test was used to compare pre- and postmedialization EAT-10 scores. RESULTS Forty-four patients met criteria and underwent either vocal fold injection (73%) or thyroplasty (27%). Etiologies of vocal fold paralysis were iatrogenic (55%), idiopathic (29%), benign or malignant neoplastic (9%), traumatic (5%), or related to the late effects of radiation (2%). EAT-10 (mean ± SD) scores improved from 12.2 ± 11.1 to 7.7 ± 7.2 after medialization (P < .01) with a follow-up of 119 ± 65 days. CONCLUSION Patients with UVFI suffer from dysphagia and report significant improvement in swallowing symptoms following VFM. The symptomatic improvement appears to be durable over time.
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Affiliation(s)
- Daniel J Cates
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Naren N Venkatesan
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Brandon Strong
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Maggie A Kuhn
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Peter C Belafsky
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
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Daniero JJ, Garrett CG, Francis DO. Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014; 2:119-130. [PMID: 24883239 DOI: 10.1007/s40136-014-0044-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes.
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Affiliation(s)
- James J Daniero
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center
| | - David O Francis
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center ; Center for Surgical Quality & Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center
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10
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Cantillo-Baños E, Jurado-Ramos A, Gutiérrez-Jódas J, Ariza-Vargas L. Vocal fold insufficiency: medialization laryngoplasty vs calcium hydroxylapatite microspheres (Radiesse Voice®). Acta Otolaryngol 2013; 133:270-5. [PMID: 23145984 DOI: 10.3109/00016489.2012.728717] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The choice of technique will depend on the glottic gap observed by stroboscopy, the alteration of the Voice Handicap Index (VHI) and the recorded values of harmonics-to-noise ratio (HNR), jitter and shimmer, and the general health, age and underlying pathology. There are statistically significant differences between the values of VHI, shimmer and jitter in favour of those cases operated on within 6 months of diagnosis. Alternatives are discussed. OBJECTIVES This study analysed and compared the functional, morphological and acoustic results, after surgery, through the techniques of medialization thyroplasty and infiltration of biomaterials to correct incomplete closure of the glottis. METHODS A total of 21 patients with dysphonia due to vocal fold insufficiency (13 women and 8 men) and ages ranging between 30 and 65 years (mean age 40.84, SD 12.5) were evaluated. The material used for augmentation surgery consisted of calcium hydroxylapatite microspheres. Measurements (VHI, jitter, shimmer and HNR) were performed before surgery and at 6 and 24 months post-intervention. RESULTS Overall, statistically significant differences were observed relating to measurements (p < 0.01) and surgical techniques (p < 0.05) analyzed. In particular, these differences were located in pairs pre-surgery - 6 months post-surgery and pre-surgery - post 24 months, in the four variables, and between the two techniques used in jitter (p = 0.008), HNR (p = 0.045) and VHI (p = 0.035).
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Affiliation(s)
- Enrique Cantillo-Baños
- Otolaryngology and Head and Neck Surgery Service, Reina Sofía University Hospital, Spain.
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11
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Gastroesophageal Reflux Disease, Globus, and Dysphagia. Dysphagia 2011. [DOI: 10.1007/174_2011_340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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