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Using peak direct subglottic pressure level as an objective measure during medialization thyroplasty: a prospective
Moahmmed I Almohizea1,2, Vyas M N Prasad3,4, Raja Fakhoury3
1Otolaryngology, Head and Neck Surgery Department, King Saud University, Riyadh, Saudi Arabia. mialmohizea@ksu.edu.sa.
Summary
Peak direct subglottic pressure (PDSGP) can help surgeons choose the correct implant size during medialization thyroplasty (MT). This objective measure showed 62.5% agreement with subjective assessments for optimal glottic closure.
Area of Science:
- Otolaryngology
- Speech and Voice Science
- Surgical Innovation
Background:
- Medialization thyroplasty (MT) corrects glottic insufficiency but relies on subjective assessments for implant sizing.
- Incorrect implant size in MT can lead to persistent symptoms and suboptimal voice outcomes.
- There is a need for objective measures to guide implant selection during MT.
Purpose of the Study:
- To evaluate the utility of Peak Direct Subglottic Pressure (PDSGP) as an objective measure for determining optimal implant size during MT.
- To assess the agreement between PDSGP and surgeon's subjective assessment of glottic closure and voice quality.
Main Methods:
- A prospective study involving patients undergoing MT with the Montgomery Implant.
- Surgeons used standard subjective assessments to select implant size.
- PDSGP was measured intraoperatively via a catheter inserted through the cricothyroid membrane for each implant size.
Main Results:
- The agreement between the chosen implant size and the lowest PDSGP recorded was 62.5% (95% CI 44-79%).
- PDSGP measurement was easily performed and did not result in any complications.
- PDSGP demonstrated a significant increase in cases of glottic insufficiency.
Conclusions:
- PDSGP is a valuable, objective tool that can aid surgeons in selecting the appropriate implant size during MT.
- Incorporating PDSGP measurements may improve surgical outcomes for glottic insufficiency.
- Further research can explore refining PDSGP's role in optimizing MT procedures.
