Comparison of voice and swallowing parameters after endoscopic total and partial arytenoidectomy for bilateral abductor vocal fold paralysis: a randomized trial.

IMPORTANCE Total arytenoidectomy is claimed to increase risk of aspiration and cause more voice loss than other operations performed for bilateral abductor vocal fold paralysis (BVFP). However, objective evidence for such a conclusion is lacking. There is no study comparing swallowing and voice after total and partial arytenoidectomy. OBJECTIVE To compare voice and swallowing parameters after endoscopic total and partial arytenoidectomy for BVFP. DESIGN, SETTING, AND PARTICIPANTS In this prospective, randomized, double-blind, case-control study conducted at a tertiary referral university, the study population comprised 20 patients with BVFP. INTERVENTIONS Endoscopic total and partial arytenoidectomy. MAIN OUTCOMES AND MEASURES Decannulation, duration of operation, Voice Handicap Index, acoustic and aerodynamic analysis, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale. RESULTS Median duration of partial and total arytenoidectomies were 59 and 49 minutes, respectively. This difference was statistically significant (P = .04). Comparisons of preoperative and postoperative Voice Handicap Index, acoustic and aerodynamic measures, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale were not statistically significantly different between both groups. CONCLUSIONS AND RELEVANCE Endoscopic total and partial arytenoidectomy are very successful static surgical options for BVFP. Partial takes longer than total arytenoidectomy. They both provide a comfortable airway, acceptable voice, and acceptable deglutition. It may be a sound practice to perform partial arytenoidectomy initially for primary BVFP cases and reserve total arytenoidectomy for revision cases. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01824849.

[1]  T. Yılmaz.  Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: A new flap technique and personal experience with 50 cases , 2012, The Laryngoscope.

[2]  C. Rosen,et al.  Arytenoid and posterior vocal fold surgery for bilateral vocal fold immobility , 2011, Current opinion in otolaryngology & head and neck surgery.

[3]  G. Friedrich,et al.  Surgery of adult bilateral vocal fold paralysis in adduction: history and trends , 2008, European Archives of Oto-Rhino-Laryngology.

[4]  G. Dursun,et al.  Aerodynamic, acoustic and functional results of posterior transverse laser cordotomy for bilateral abductor vocal fold paralysis , 2006, The Journal of Laryngology & Otology.

[5]  Jackie L. Gartner-Schmidt,et al.  Medial Arytenoidectomy versus Transverse Cordotomy as a Treatment for Bilateral Vocal Fold Paralysis , 2005, The Annals of otology, rhinology, and laryngology.

[6]  M. Remacle,et al.  Subtotal Carbon Dioxide Laser Arytenoidectomy for the Treatment of Bilateral Vocal Fold Immobility: Long-Term Results , 2005, The Annals of otology, rhinology, and laryngology.

[7]  J. Salassa.  A Functional Outcome Swallowing Scale for Staging Oropharyngeal Dysphagia , 2000, Digestive Diseases.

[8]  A. Blitzer,et al.  Evaluation and Management of Bilateral Vocal Cord Immobility , 1999, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[9]  M. Remacle,et al.  Subtotal Carbon Dioxide Laser Arytenoidectomy by Endoscopic Approach for Treatment of Bilateral Cord Immobility in Adduction , 1996, The Annals of otology, rhinology, and laryngology.

[10]  R. Crumley.  Endoscopic Laser Medial Arytenoidectomy for Airway Management in Bilateral Laryngeal Paralysis , 1993, The Annals of otology, rhinology, and laryngology.

[11]  O. Kleinsasser,et al.  [Report on the indication, technique and functional results of endolaryngeal arytenoidectomy and submucous partial chordectomy in bilateral paralysis of vocal cord (author's transl)]. , 1981, Laryngologie, Rhinologie, Otologie.

[12]  W. C. Thornell.  A new intralaryngeal approach in arytenoidectomy in bilateral abductor paralysis of the vocal cords; report of three cases. , 1949, Archives of otolaryngology.