OBJECTIVES/HYPOTHESIS: To assess the possible predictive factors for permanent laryngoplasty (PL) in patients with acute unilateral vocal fold paralysis (UVFP), and to assess the effects of early vocal cord hyaluronic acid injection. STUDY DESIGN: Prospective cohort study. METHODS:Patients diagnosed with UVFP within the previous 6 months were enrolled. Initial and follow-up videolaryngostroboscopy, voice laboratory analysis, laryngeal electromyography, and Voice Outcome Survey were performed. RESULTS:Fifty newly diagnosed UVFP patients were recruited. Eight were excluded after 12 months of follow-up and data for 42 patients were analyzed. In patients treated conservatively, the glottal gap was measured on presentation. Normalized glottal gap area (NGGA) was the only predictor of PL (P = 0.036) according to multivariate logistic regression analysis. A cutoff value of 7.36 resulted in sensitivity of 85.7% and specificity of 80.0% for predicting future PL. The PL rate was significantly higher in patients with an initial NGGA > 7.36 compared with ≤ 7.36. (6/9 vs. 1/13; χ(2) = 6.71; P = 0.010). Among patients with an initial NGGA > 7.36, those who accepted early hyaluronic acid injection had a significantly lower rate of PL (1/11 vs. 6/9; χ(2) = 7.21; P = 0.007) and better social and emotional role functioning at follow-up. CONCLUSIONS: The glottal gap on presentation is a robust early predictor of PL. Early, office-based hyaluronic acid intracordal injection can reduce the need for PL in patients with a large NGGA.
RCT Entities:
OBJECTIVES/HYPOTHESIS: To assess the possible predictive factors for permanent laryngoplasty (PL) in patients with acute unilateral vocal fold paralysis (UVFP), and to assess the effects of early vocal cord hyaluronic acid injection. STUDY DESIGN: Prospective cohort study. METHODS:Patients diagnosed with UVFP within the previous 6 months were enrolled. Initial and follow-up videolaryngostroboscopy, voice laboratory analysis, laryngeal electromyography, and Voice Outcome Survey were performed. RESULTS: Fifty newly diagnosed UVFP patients were recruited. Eight were excluded after 12 months of follow-up and data for 42 patients were analyzed. In patients treated conservatively, the glottal gap was measured on presentation. Normalized glottal gap area (NGGA) was the only predictor of PL (P = 0.036) according to multivariate logistic regression analysis. A cutoff value of 7.36 resulted in sensitivity of 85.7% and specificity of 80.0% for predicting future PL. The PL rate was significantly higher in patients with an initial NGGA > 7.36 compared with ≤ 7.36. (6/9 vs. 1/13; χ(2) = 6.71; P = 0.010). Among patients with an initial NGGA > 7.36, those who accepted early hyaluronic acid injection had a significantly lower rate of PL (1/11 vs. 6/9; χ(2) = 7.21; P = 0.007) and better social and emotional role functioning at follow-up. CONCLUSIONS: The glottal gap on presentation is a robust early predictor of PL. Early, office-based hyaluronic acid intracordal injection can reduce the need for PL in patients with a large NGGA.
Authors: Chang Hwan Ryu; Seung Jin Lee; Jae-Gu Cho; Ik Joon Choi; Yoon Seok Choi; Yong Tae Hong; Soo Yeon Jung; Ji Won Kim; Doh Young Lee; Dong Kun Lee; GIljoon Lee; Sang Joon Lee; Young Chan Lee; Yong Sang Lee; Inn Chul Nam; Ki Nam Park; Young Min Park; Eui-Suk Sung; Hee Young Son; In Hyo Seo; Byung-Joo Lee; Jae-Yol Lim Journal: Clin Exp Otorhinolaryngol Date: 2021-06-01 Impact factor: 3.372