Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-27T22:12:51.987Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis

Published online by Cambridge University Press:  18 March 2016

M B Asik ,
O Karasimav ,
H Birkent ,
A L Merati ,
M Gerek  and
Y Yildiz
M B Asik*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
O Karasimav
Affiliation:
Department of Sports Medicine, Gulhane Military Medical Academy, Ankara, Turkey
H Birkent
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
A L Merati
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, USA
M Gerek
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
Y Yildiz
Affiliation:
Department of Sports Medicine, Gulhane Military Medical Academy, Ankara, Turkey
*
Address for correspondence: Dr M Burak Asik, Gulhane Askeri Tip Akademisi, KBB AD, 06018 Etlik, Ankara, Turkey E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Carbon dioxide laser posterior transverse cordotomy is a common option for bilateral vocal fold paralysis. This study prospectively evaluated aerodynamic and acoustic effects of unilateral carbon dioxide laser posterior transverse cordotomy in bilateral vocal fold paralysis patients.

Methods:

The study comprised 11 bilateral vocal fold paralysis patients (9 females, 2 males), with a mean age of 46.6 ± 14.1 years. All patients were treated by laser posterior transverse cordotomy. Pre-operative and two-month post-operative assessments were conducted, including: dyspnoea scales, maximum phonation time measurement, spirometry and bicycle ergometry.

Results:

All subjective and objective aerodynamic parameters showed statistically significant improvements between the pre- and post-operative period. Objective spirometric and ergometric parameters showed a significant increase post-operatively. The changes in objective voice parameters (fundamental frequency (f0), jitter, shimmer, soft phonation index and noise-to-harmonic ratio) were statistically non-significant; however, there was a significant improvement in subjective voice parameters post-operatively, as assessed by the voice handicap index and grade-roughness-breathiness-asthenia-strain scale (p = 0.026 and p = 0.018 respectively).

Conclusion:

Unilateral carbon dioxide laser posterior transverse cordotomy is an effective procedure that results in improved dyspnoea and aerodynamic performance with some worsening of voice parameters.

Keywords

Vocal Cord ParalysisCordotomyRespirationVoiceSpirometry
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 4 , April 2016 , pp. 373 - 379
Copyright
Copyright © JLO (1984) Limited 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented orally at the Fall Voice Conference, 23–25 October 2014, San Antonio, Texas, USA.

References

1Segas, J, Stavroulakis, P, Manolopoulos, L, Yiotakis, J, Adamopoulos, G.Management of bilateral vocal fold paralysis: experience at the University of Athens. Otolaryngol Head Neck Surg 2001;124:68–71Google Scholar
2Dursun, G, Gokcan, MK.Aerodynamic, acoustic and functional results of posterior transverse laser cordotomy for bilateral abductor vocal fold paralysis. J Laryngol Otol 2006;120:282–8CrossRefGoogle ScholarPubMed
3Loughran, S, Alves, C, MacGregor, FB.Current aetiology of unilateral vocal fold paralysis in a teaching hospital in the West of Scotland. J Laryngol Otol 2002;116:907–10Google Scholar
4Rosenthal, LH, Benninger, MS, Deeb, RH.Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 2007;117:1864–70Google Scholar
5Feehery, JM, Pribitkin, EA, Heffelfinger, RN, Lacombe, VG, Lee, D, Lowry, LD et al. The evolving etiology of bilateral vocal fold immobility. J Voice 2003;17:76–81CrossRefGoogle ScholarPubMed
6Dennis, DP, Kashima, H.Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1989;98:930–4Google Scholar
7Gokcan, MK, Kurtulus, DF, Ustuner, E, Ozyurek, E, Kesici, GG, Erdem, SC et al. A computational study on the characteristics of airflow in bilateral abductor vocal fold immobility. Laryngoscope 2010;120:1808–18Google Scholar
8Li, Y, Pearce, EC, Mainthia, R, Athavale, SM, Dang, J, Ashmead, DH et al. Comparison of ventilation and voice outcomes between unilateral laryngeal pacing and unilateral cordotomy for the treatment of bilateral vocal fold paralysis. ORL J Otorhinolaryngol Relat Spec 2013;75:68–73Google Scholar
9Sapundzhiev, N, Lichtenberger, G, Eckel, HE, Friedrich, G, Zenev, I, Toohill, RJ et al. Surgery of adult bilateral vocal fold paralysis in adduction: history and trends. Eur Arch Otorhinolaryngol 2008;265:1501–14Google Scholar
10Olthoff, A, Zeiss, D, Laskawi, R, Kruse, E, Steiner, W.Laser microsurgical bilateral posterior cordectomy for the treatment of bilateral vocal fold paralysis. Ann Otol Rhinol Laryngol 2005;114:599–604Google Scholar
11Moorthy, R, Balfour, A, Jeannon, JP, Simo, R.Recurrent laryngeal nerve palsy in benign thyroid disease: can surgery make a difference? Eur Arch Otorhinolaryngol 2012;269:983–7Google Scholar
12Jacobson, BH.The voice handicap index (VHI): development and validation. Am J Speech Lang Pathol 1997;6:337–44Google Scholar
13Havas, T, Lowinger, D, Priestley, J.Unilateral vocal fold paralysis: causes, options and outcomes. Aust N Z J Surg 1999;69:509–13Google Scholar
14Mahler, DA, Wells, CK.Evaluation of clinical methods for rating dyspnea. Chest 1988;93:580–6Google Scholar
15Camargo, LA, Pereira, CA.Dyspnea in COPD: beyond the modified Medical Research Council scale. J Bras Pneumol 2010;36:571–8Google Scholar
16Wilmore JH, Costill DL. Physiology of Sport and Exercise, 2nd edn.Champaign, Illinois: Human Kinetics, 1999;516–31Google Scholar
17Hans, S, Vaissiere, J, Crevier-Buchman, L, Laccourreye, O, Brasnu, D.Aerodynamic and acoustic parameters in CO2 laser posterior transverse cordotomy for bilateral vocal fold paralysis. Acta Otolaryngol 2000;120:330–5Google Scholar
18Maurizi, M, Paludetti, G, Galli, J, Cosenza, A, Di Girolamo, S, Ottaviani, F.CO2 laser subtotal arytenoidectomy and posterior true and false cordotomy in the treatment of post-thyroidectomy bilateral laryngeal fixation in adduction. Eur Arch Otorhinolaryngol 1999;256:291–5Google Scholar
19Kashima, HK.Documentation of upper airway obstruction in unilateral vocal cord paralysis: flow-volume loop studies in 43 subjects. Laryngoscope 1984;94:923–37Google Scholar
20Lawson, G, Remacle, M, Hamoir, M, Jamart, J.Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: functional results. J Voice 1996;10:314–19CrossRefGoogle ScholarPubMed