Changes in ventilatory function following surgery for bilateral abductor paralysis

Management of bilateral vocal fold immobility continues to remain a challenge for the Otolaryngologist who attempts to create a balance between creation of an adequate airway and preservation of voice. The flow volume loop obtained by spirometry provides an ideal objective assessment tool to evaluate the results of surgery for this condition. Our experience in using peak inspiratory flow rate (PIFR) and forced inspiratory flow with 50% of vital capacity (FIF(50)) in the lung in assessing the results of surgery is described. Seventeen patients were included in the study. The surgical procedures performed included laser posterior cordectomy with partial arytenoidectomy, endoscopic arytenoidectomy and posterior cordectomy-Kashima's technique. Twelve out of 17 patients were successfully decannulated, a success rate of 70.6%. All patients except one showed an increase in mid-inspiratory flow rates and peak inspiratory flow rates. The mean increase in FIF(50) was 0.44 l/sec (52.6%) and the mean increase in PIFR was 0.41l/sec (39.77%). No statistically significant difference in improvement of inspiratory flow rates was observed between the three surgical procedures used in the study.