Very long-term Voice Handicap Index Voice Outcomes after Montgomery Thyroplasty: A cross-sectional study

Quality of Life in Recurrent Respiratory Papillomatosis Patients after Vocal Fold Surgery: An In-Depth Exploration

INTRODUCTION

This study explores the quality of life among patients with recurrent respiratory papillomatosis (RRP) after vocal fold surgery as measured by the outcome scores of the Voice Handicap Index (VHI) and the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis (DT&PL). Differences in quality of life were explored within the independent variables age, surgical frequency, weeks since last vocal fold operation, gender, HPV type, surgical location, vaccination with Gardasil©, and a patient's request to speak with a speech-language pathologist.

METHODS

A single-center, observational cohort study was conducted using VHI and DT&PL scores and demographic and clinical data obtained from patient files. Inclusion criteria were a confirmed HPV type, age 18 years or older, the ability to fill in both questionnaires in Dutch, and having undergone at least one surgical procedure to remove laryngeal papilloma. Relationships of the independent variables with VHI and Distress Thermometer (DT) scores were explored using univariable and multivariable regressions and linear regression models.

RESULTS

Of 271 RRP patients, 100 met the inclusion criteria and responded to requests to fill in both questionnaires with a minimum of 12 weeks after their last operation. Our study showed a statistically significant negative relationship between age and VHI scores (p = 0.02) in the univariable, and multiple linear regressions (p = 0.01), indicating that patients experienced fewer self-perceived functional voice disabilities with each increase in age. A parallel negative relationship is seen between the variables age (p = 0.03) and DT scores. Our results showed a statistically significant positive relationship between the number of vocal fold surgeries and DT scores (p = 0.03).

CONCLUSION

The results of this study show a significant relationship between age, surgical frequency, and quality of life in patients with RRP. Older patients have lower Voice Handicap Index (VHI) and Distress Thermometer (DT) scores, indicating fewer self-perceived voice and disease-related quality of life problems. Conversely, a rise in surgical frequency is significantly associated with higher DT scores, reflecting greater disease-related distress.

Translation and Cross-Cultural Adaptation of the Thyroidectomy-Related Voice Questionnaire (TVSQ) in Greek Population

OBJECTIVES

The Thyroidectomy-Related Voice Questionnaire (TVSQ) is a useful tool in the detection of voice changes and dysfunctions and the diagnosis of other symptoms related to transient or permanent laryngeal nerve damage in patients after thyroidectomy. The aim of our study is the translation and validation of (TVSQ) in the Greek language and in Greek population for the first time.

METHODS

The TVSQ was translated from English to Greek and vice versa by two independent researchers, while before the application of the TVSQ in clinical practice, a control group of 20 people was used. The following methods were used for the weighting and analysis of the TVSQ: Polychoric correlation, Cronbach's alpha, confirmatory factor analysis, and item response theory (IRT).

RESULTS

Polychoric correlations revealed that questions 1-10 have a strong positive correlation with each other, while the correlation of the rest of the TVSQ items is positive. Subsequently, for the first subgroup of questions ("voice change") Cronbach's alpha was equal to 0.950, while for the second ("throat and neck discomfort") Cronbach's alpha was equal to 0.846. Thus, we conclude that the internal consistency reliability is high for both subgroups of TVSQ questions. With the IRT method we showed that for the first subgroup of questions ("voice change"), the item with the least predictive value is question 5, while for the second subgroup of questions ("throat and neck discomfort"), the item with the least educational value was question 15.

CONCLUSIONS

Our team translated and validated the TVSQ with the above statistical methods in the Greek language, so that it can be used as a valuable tool in clinical practice, and more specifically in patients undergoing thyroidectomy. TVSQ can play a significant role on the diagnosis of either postoperative voice disorders and other symptoms related to thyroidectomy.

Modified Montgomery thyroplasty: Customisation of the cartilage window according to laryngeal anatomy

We described a Montgomery's thyroplasty using a set of measurement devices designed to achieve accurate individualised prosthesis placement. The objective of the present study was to describe the surgical techniques employed via a step-by-step video and show our results. In total, 42 modified thyroplasties were performed during the 10-year study period. The verification of both points: adequate location and size of the prosthesis are the keys to the success of this intervention. The individualisation of the cartilage window location produces optimal functional results in patients post-intervention in terms of the MPT, GRB score, and VHI-30.

Long-term voice evaluation after arytenoid adduction surgery in patients with unilateral vocal fold paralysis

PURPOSE

Laryngeal framework surgery, including medialization laryngoplasty and arytenoid adduction (AA), is expected to have a lasting or permanent effect in patients with unilateral vocal fold paralysis (UVFP); however, there are few reports about the long-term outcomes of AA. This study aimed to evaluate the long-term postoperative effects of AA surgery and examine its stability and reliability.

METHODS

This study collected the voice handicap index (VHI) questionnaire from patients with UVFP who underwent AA more than 2 years previously. The VHI values preoperatively and 3 months postoperatively (early postoperative evaluation) were retrospectively calculated, and VHI values more than 2 years after surgery (late postoperative evaluation) were collected by mailing a sheet to the patients and asking to fill and return it. Possible influenced subscales such as age, sex, causes of UVFP, affected side, and surgeons were also analyzed.

RESULTS

A total of 77 patients with UVFP who underwent AA had significantly lower early and late postoperative evaluations than preoperative evaluations. In 38 patients with no missing values, there were no significant differences between early and late postoperative evaluations, measured at a median of approximately 5 years. There were also no significant differences between early and late postoperative evaluations in any of the subscale groups.

CONCLUSION

Patients with UVFP who underwent AA surgery achieved stable voice improvement in the long term after surgery.

Anesthetic Technique and Functional Outcomes in Modified Montgomery Thyroplasty

BACKGROUND

Montgomery thyroplasty type I is a surgical technique indicated in vocal cord paralysis which consists of the paralyzed cord medialization, improving the voice quality. The objective of the study is to describe in detail the anesthetic method to obtain optimal post-medialization voice results.

METHODOLOGY

Retrospective case series study including patients who underwent medialization thyroplasty using the modified Montgomery technique at the General University Hospital of Valencia between 2011 and 2021. The anesthetic technique consisted of general anesthesia with neuromuscular relaxation and a laryngeal mask. Pre- and post-surgical vocal functional data of maximum phonation times (MPT), G score, and Voice Handicap Index-30 (VHI-30) were evaluated.

RESULTS

All the patients presented an improvement in voice results, increasing MPT after surgery and a decrease in VHI-30 and G score postoperatively, with statistically significant differences between the pre- and post-surgical results (p-value < 0.05). There were no complications related to anesthesia or surgery.

CONCLUSIONS

The use of general anesthesia with muscle relaxation in modified Montgomery thyroplasty may be a good option to consider. The use of a laryngeal mask for ventilation combined with a fiberoptic check allows direct visualization of the vocal cords intraoperatively, providing good functional voice results.

Investigating the Impact of Voice Impairment on Quality of Life in Stroke Patients: The Voice Handicap Index (VHI) Questionnaire Study

The Voice Handicap Index (VHI) is a patient-centered evaluation tool specifically designed for assessing voice-related quality of life. Although the VHI has been extensively used in patients with voice disorders, its applicability in stroke patients has not been fully established. This prospective cross-sectional study aimed to investigate the feasibility of using the VHI questionnaire in identifying stroke patients with voice problems. The study included a cohort of acute to subacute first-ever stroke patients (n = 48), with or without voice problems, as well as other non-stroke patients (n = 31) who agreed to complete the VHI questionnaire. Stroke patients with self-reported voice problems demonstrated significantly higher VHI scores and poorer life quality scores compared to the control groups. These patients also had lower Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), and Euro-QoL-5D-5L (EQ-5D-5L) scores. Spearman correlation analysis revealed an inverse association between VHI scores and EQ-5D-5L (rho = -0.77, p < 0.001), Korean Mann Assessment of Swallowing Ability (rho = -0.51, p < 0.001), and other functional parameters, including the National Institutes of Health Stroke Scale, MMSE, and MBI scores. Multiple regression analysis indicated that the VHI score was the biggest contributing factor to EQ scores. This is the first study to demonstrate that stroke patients with voice problems may experience reduced quality of life, even after controlling for other confounding factors such as dysphagia or neurological deficits. Future studies are needed whether addressing these issues by implementing the VHI may facilitate the improvement of patients' quality of life.

Long-term voice outcomes of laryngeal framework surgery for unilateral vocal fold paralysis

OBJECTIVE

To evaluate the short- and long-term voice outcomes after unilateral medialization thyroplasty (MT) and unilateral medialization thyroplasty with arytenoid adduction (MT + AA) in patients with unilateral vocal fold paralysis.

METHODS

Voice outcomes were assessed preoperatively, and postoperatively at 3 and 12 months according to a standardized protocol. Voice assessment was performed using Voice Handicap Index (VHI), GRBAS Grade, Maximum Phonation Time (MPT), s/z-ratio and subjective numeric rating scales on voice quality, effort, performance and influence on life.

RESULTS

Sixty-one patients were included (34 MT and 27 MT + AA). Significant pre- to postoperative improvements were seen in all voice outcome parameters. No significant differences in post-operative values were identified between the groups.

CONCLUSION

Based on our findings, we conclude that patients with unilateral vocal fold paralysis who undergo MT and MT + AA achieve comparable and significant long time voice improvement, although voices do not completely normalize. We also conclude that this does not mean that AA is a superfluous procedure, but can indicate the accurate identification of patients in need of the additional AA procedure based on clinical parameters.

Accuracy of Thyroid Cartilage Fenestration During Montgomery Medialization Thyroplasty

INTRODUCTION

Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy.

MATERIAL AND METHOD

Study was performed by virtually drawing the fenestration on a 3D CT scan as proposed by the MTIS's instructions for use (the "expected window" (EW)), and comparing it to the actually realized fenestration (the "realized window "(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW (°), and (d) the orientation of RW's center, were studied and compared to MPT (seconds) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed.

RESULTS

The median overlapping surface was 58.8 % [34.6; 75.4]. The median radius was 3.2 mm [1.7; 4.1]. The median angle was 16° [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance, or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance, or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males.

CONCLUSIONS

Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients.