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Better Outcome After Thyroplasty Type I in Unilateral Vocal Fold Paralysis Without Synkinesis and
Annabella Kurz1, Guan-Yuh Ho1, Matthias Leonhard1
1Department of Otorhinolaryngology, Medical University of Vienna, Austria.
Importance:
Thyroplasty type I is considered standard therapy in patients with chronic unilateral vocal fold paralysis (UVFP); revisions are frequently required.
Objective:
The aim of the study was whether synkinesis affects thyroplasty type I.
Design:
Retrospective data analysis.
Participants:
Patients with UVFP (age ≥18 years) after thyroplasty type I.Intervention of exposures: Between November 2019 and November 2022, 28 patients with chronic UVFP underwent thyroplasty type I and were followed up 6 months postoperatively. Prior to surgery, all patients underwent laryngeal electromyography (LEMG).
Main Outcome Measures:
Dysphonia Severity Index (DSI), perceptual voice sound analysis (GRBAS), voice acoustics (jitter %), maximum phonation time (MPT), voice range profile measurements (VRP), Voice Handicap Index (VHI-9), and laryngo(strobo)scopic findings were assessed preoperatively and up to 6 months after thyroplasty. For study purposes, the presence of synkinesis was retrospectively evaluated and classified according to the Crumley classification based on preoperative data. Statistical analyses were exploratory. A linear mixed-effects model was used to asses preoperative and postoperative DSI in patients with and without synkinesis. Statistical analyses were carried out with SPSS version 27.
Results:
Sixteen patients had a UVFP without and 12 with synkinesis. Among patients with synkinesis, 25% were classified as Crumley type II, 50% as type IV, and 25% as undefined. DSI improved significantly postoperatively across all patients (P = .006). The greatest improvement in GRBAS score, MPT, and Jitter (%) were observed in UVFP patients with type IV and those without synkinesis. VHI-9 scores improved in patients with type IV synkinesis (n = 6) and those without synkinesis (n = 16). Complete glottal closure was achieved in most patients with (n = 7) and without synkinesis (n = 12).
Conclusion:
This study emphasizes the importance of preoperative LEMG in chronic UVFP before thyroplasty type I to identify unfavorable synkinesis types, as routine laryngo(strobe)scopy and voice acoustic evaluation do not allow any conclusion on aberrant reinnervation processes.
Relevance:
Patients with type IV are suitable candidates for thyroplasty type I. In type II and undefined synkinesis, thyroplasty type I alone is insufficient, and additional therapies should be considered.
