Transverse Cordotomy With Medial Arytenoidectomy Effectively Treats Bilateral Vocal Fold Immobility

Transverse cordotomy with medial arytenoidectomy (TCMA) for bilateral vocal fold immobility (BVFI) can optimize a patient's respiratory status and promote tracheostomy decannulation, but has the potential to adversely affect voice and swallow function. We present the largest cohort to date evaluating the procedure's effectiveness and compare functional outcomes by etiology of BVFI.

Retrospective case series of consecutive patients treated at a tertiary care center from April 2014 to 2024. All patients who underwent TCMA for posterior glottic stenosis (PGS) or bilateral vocal fold paralysis (BVFP) were included. Exclusion criteria were multi-level stenosis and prior airway resection or reconstruction. We assessed rate of decannulation, Voice handicap index (VHI), dyspnea index (DI), eating assessment tool (EAT-10), and cough severity index (CSI) scores and compared outcomes by surgical indication.

Forty-five patients were included and the majority had PGS (64%). Seventy six percent of tracheostomy dependent patients were decannulated. Surgical indication did not impact time to decannulation or number of interventions required for decannulation. DI was improved at 1-month post-operation and last clinic visit (p < 0.0001). DI was slightly improved for the PGS cohort at last clinic visit, compared to the BVFP cohort (p = 0.04). There were no differences in VHI, EAT-10, or CSI after surgery compared with baseline, or differences based on BVFI etiology.

TCMA is an effective surgical intervention for BVFI that provides a reliable rate of decannulation and improves respiratory function without compromising voice or swallowing outcomes, regardless of the BVFI etiology.