Tadeus Nawka1, Christian Sittel2, Christoph Arens3, Ruth Lang-Roth4, Claus Wittekindt5, Rudolf Hagen6, Andreas H Mueller7, Ahmed I Nasr1, Orlando Guntinas-Lichius8, Gerhard Friedrich9, Markus Gugatschka9. 1. Department of Audiology and Phoniatrics, Charité-Medical University of Berlin, Berlin, Germany. 2. Department of Otorhinolaryngology, Head and Neck Surgery, Katharinenhospital Stuttgart, Stuttgart, Germany. 3. Department of Otorhinolaryngology, Head and Neck Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany. 4. Phoniatrics and Paediatric Audiology Department, University Clinic of Cologne, Cologne, Germany. 5. Department of Audiology, University Clinic of Giessen and Marburg, Marburg, Germany. 6. Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery Department, University of Würzburg, Würzburg, Germany. 7. Department of Otorhinolaryngology and Plastic Surgery, SRH Wald-Klinikum Gera, Gera, Germany. 8. Department of Otorhinolaryngology, Head and Neck Surgery, University Clinic of Jena, Jena, Germany. 9. ENT University Hospital Graz, Division of Phoniatrics, Medical University Graz, Graz, Austria.
Abstract
OBJECTIVES/HYPOTHESIS: Bilateral vocal fold paralysis (BVFP) is a rare but life-threatening condition mostly caused by iatrogenic damage to the peripheral recurrent laryngeal nerve. Endoscopic enlargement techniques have been the standard treatment for decades. However, prospective studies using internationally accepted phoniatric and respiratory evaluation guidelines are rare. STUDY DESIGN: Prospective observational multicenter study. METHODS: Twelve clinical centers screened 61 patients, of whom 36 were eligible according to the study protocol. Subjects were assessed with specific phoniatric and respiratory tests preoperatively and at 1 and 6 months postoperatively. RESULTS: Important respiratory parameters improved significantly 6 months postoperatively (peak expiratory and expiratory flow), confirming that a glottal enlargement effectively reduced the obstruction. Objective parameters dealing with voice quality worsened significantly (maximum phonation time, voice range profile, hoarseness), whereas subjective voice assessment (VHI-12) did not change significantly. CONCLUSION: Endoscopic glottal enlargement is an effective method for relieving symptoms of dyspnea due to BVFP. Postoperatively, voice quality objectively worsened; however, this was not perceived by the patients themselves. Laryngostroboscopic findings did not correlate strongly with voice and respiratory outcomes. LEVEL OF EVIDENCE: 2b.
OBJECTIVES/HYPOTHESIS: Bilateral vocal fold paralysis (BVFP) is a rare but life-threatening condition mostly caused by iatrogenic damage to the peripheral recurrent laryngeal nerve. Endoscopic enlargement techniques have been the standard treatment for decades. However, prospective studies using internationally accepted phoniatric and respiratory evaluation guidelines are rare. STUDY DESIGN: Prospective observational multicenter study. METHODS: Twelve clinical centers screened 61 patients, of whom 36 were eligible according to the study protocol. Subjects were assessed with specific phoniatric and respiratory tests preoperatively and at 1 and 6 months postoperatively. RESULTS: Important respiratory parameters improved significantly 6 months postoperatively (peak expiratory and expiratory flow), confirming that a glottal enlargement effectively reduced the obstruction. Objective parameters dealing with voice quality worsened significantly (maximum phonation time, voice range profile, hoarseness), whereas subjective voice assessment (VHI-12) did not change significantly. CONCLUSION: Endoscopic glottal enlargement is an effective method for relieving symptoms of dyspnea due to BVFP. Postoperatively, voice quality objectively worsened; however, this was not perceived by the patients themselves. Laryngostroboscopic findings did not correlate strongly with voice and respiratory outcomes. LEVEL OF EVIDENCE: 2b.
Authors: T Salmen; T Ermakova; A Schindler; S-R Ko; Ö Göktas; M Gross; T Nawka; P P Caffier Journal: Acta Otorhinolaryngol Ital Date: 2018-06 Impact factor: 2.124
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