COMPARISON OF LATERALIZATION THYROPLASTY AND LASER CORD WEDGE RESECTION IN TERMS OF VOICE QUALITY IN PATIENTS WITH BILATERAL ABDUCTOR VOCAL CORD PARALYSIS

Abstract

AbstractBackground/Aims: It was aimed to compare lateralization thyroplasty with laser cord wedge resection in terms of postoperative voice analysis, duration of hospital stay, tracheotomy rate, and decannulation time in patients with bilateral abductor vocal cord paralysis. Methods: A total of 37 patients who presented to our department with bilateral abductor vocal cord paralysis between February 2005 and February 2009 were enrolled in this prospective study. External arytenoid lateralization (lateralization thyroplasty) was randomly performed in 22 patients and laser posterior cordotomy was performed in 15 patients. Fifteen healthy volunteers were assigned to the control group. Postoperative 6th month maximum phonation time (MPT), S/Z ratio, and the results of objective voice analysis [mean frequency perturbation (jitter), mean amplitude perturbation (shimmer), mean fundamental frequency (fo), and NHR (noise to harmonic ratio)] were compared between the two groups and the control group. Decannulation time, patient tracheotomy status, and duration of hospital stay were also recorded.Results: The mean postoperative MPT decreased but S/Z ratio increased in both patient groups compared to the control group. The mean MPT was shorter in the external arytenoid lateralization group versus the laser posterior cordotomy group (p= 0.011). There was no statistically significant difference between the external arytenoid lateralization and laser posterior cordotomy groups in terms of mean S/Z ratio (p= 0.306). It was observed that jitter, shimmer, and NHR values were increased, i.e. voice quality impaired, in both patient groups. Jitter (p= 0.004), shimmer (p lt;0.001), and NHR (p= 0.052) values were significantly increased in the laser posterior cordotomy group as compared with the external arytenoid lateralization group. No statistically significant difference was found between the external arytenoid lateralization group and the laser posterior cordotomy group in terms of the mean postoperative f(o) (p= 0.417), as well as for decannulation time (p= 0.076) and duration of hospital stay (p= 2.30).Conclusions: External arytenoid lateralization is a more preferable technique than laser posterior cordotomy because it preserves mucosal integrity and cord mass, which results in better voice quality.

Keywords

• lateralization thyroplasty
• laser cordectomy
• jitter
• shimmer