Effect of Medialisation Procedures in Patients with Phonatory Gap

Author Uzma Rehman
Co-Author Bhagyashree Bokare, Seema Patel, Devendra Mahore, Ashish Keche
DOI https://ww

Country : India
Subject : E.N.T

Keywords : Glottic insufficiency, glottal closure, Fat injection Laryngoplasty, Type 1 Thyroplasty

Abstract

Background: Glottic insufficiency is the inability of true vocal folds to approximate completely in midline during phonation (1). Glottic insufficiency occurs mainly due to vocal fold motion impairment (eg palsy, paresis), soft tissue loss, vocal fold atrophy and scarring. (4) Glottic insufficiency is amenable to treatment and various therapy regimens have been reported with variable effectiveness for treatment of glottic insufficiency with main goal to make the deviated vocal fold closer to midline to facilitate glottal closure during phonation and swallowing (3). However, the main stay of management remains surgical - medialization procedures including Type 1 Thyroplasty and Fat Injection Laryngoplasty (2). This study gives opportunity to assess the effect of these medialisation procedures on voice related outcomes and improvement on glottal closure. Methods: A Prospective study was carried out on 12 subjects who underwent Fat Injection Laryngoplasty or type 1 Thyroplasty. Outcomes were assessed based on post operative improvement in symptoms assessed by VHI-10 score, glottal closure on laryngoscopy and Maximum Phonation Time (MPT) immediately after surgery and on follow up at 1st month and 6th month after procedure. Results: Total of 12 patients were studied whose MPT showed improvement from 5.33+0.88 secs preoperatively to 10.16 + 1.02 secs immediately after surgery, 10.67+ 0.98 secs 1 month after surgery and 10.08+ 1.31 secs 6 months after surgery. VHI also showed significant improvement from 26.08 + 1.39 preoperative value to 21.91 + 1.24 immediately after surgery, 11.91 + 2.10 after 1 month and 11.5 + 2.81 after 6 months of procedure. Conclusions: Medialisation procedures (Fat injection Laryngoplasty and Type 1 Thyroplasty) are found to yield significant improvement in voice related outcomes and closure of phonatory gap from immediate post op period when followed up to 6 months post procedure.

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