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Laryngoscope. 2011 Jun;121(6):1252-60. doi: 10.1002/lary.21780. Epub 2011 May 6.

Prospective multi-arm evaluation of surgical treatments for vocal fold scar and pathologic sulcus vocalis.

Author information

  • 1Division of Otolaryngology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin, USA. welham@surgery.wisc.edu

Abstract

OBJECTIVES/HYPOTHESIS:

The purpose of this study was to compare the clinical effectiveness of type I thyroplasty, injection laryngoplasty, and graft implantation for the treatment of vocal fold scar and pathologic sulcus vocalis.

STUDY DESIGN:

Prospective, multi-arm, quasi-experimental research design.

METHODS:

Twenty-eight patients with newly diagnosed vocal fold scar and/or pathologic sulcus vocalis were assigned to one of three treatment modalities: type I thyroplasty (n = 9), injection laryngoplasty (n = 9), and graft implantation (n = 10). Psychosocial, auditory-perceptual, acoustic, aerodynamic, and videostroboscopic data were collected pretreatment and at 1, 6, 12, and 18 months posttreatment.

RESULTS:

Type I thyroplasty and graft implantation both resulted in reduced voice handicap with no concomitant improvement in auditory-perceptual, acoustic, aerodynamic, or vocal fold physiologic performance. Injection laryngoplasty resulted in no improvement on any vocal function index. Patients who underwent graft implantation exhibited the slowest improvement trajectory across the 18-month follow-up period.

CONCLUSIONS:

A persistent challenge in this area is that no single treatment modality is successful for the majority of patients, and there is no evidence-based decision algorithm for matching a given treatment to a given patient. Progress therefore requires the identification and categorization of predictive clinical features that can drive evidence-based treatment assignment.

Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

PMID:
21557241
[PubMed - indexed for MEDLINE]
PMCID:
PMC3100420
Free PMC Article
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