Does improved glottal closure through framework surgery or vocal fold augmentation (VFA) improve dyspnea symptoms?
Explore this issue:February 2018
Patients with glottic insufficiency and dyspnea prior to intervention to improve glottic closure had a significant reduction in dyspnea following treatment, while those without dyspnea complaints prior to intervention had variable outcomes for dyspnea symptoms. Additionally, VFA or medialization laryngoplasty did not worsen dyspnea symptoms.
Background: Disease processes such as unilateral vocal fold paralysis (UVFP), vocal fold paresis, advancing age, and progressive neurodegenerative disease can have a deleterious effect on glottic closure. Treatment typically targets voice outcomes, but many patients anecdotally report improved deglutition and breathing following surgery.
Study design: Retrospective review of all operating room and office-based VFAs and medialization procedures performed by a single surgeon from December 2012 to September 2015.
Setting: New York University School of Medicine, New York.
Synopsis: A total of 179 patients underwent 189 procedures. Reasons for augmentation varied and included UVFP, vocal fold paresis, atrophy, scar, sulcus, mixed, and other. Across all patients, Modified Borg Dyspnea Scale (MBDS) and Modified Medical Research Council Dyspnea Scale (MMRCDS) scores did not change significantly pre- and post-procedure. A BMI of <30 resulted in greater MBDS improvement. A history of respiratory disease did not impact dyspnea following the procedures. Patients with dyspnea prior to intervention saw statistically significant improvement in both the MMRCDS and MBDS following intervention. Twenty-one of the 97 patients with both pre- and post-intervention MMRCDS values and 16 of 102 with both pre- and post-intervention MBDS values had pre-augmentation values consistent with subjective dyspnea and were included for comparison. Cardiac and respiratory comorbidities were more common in these subgroups. Dyspnea symptoms improved to normal values in 13 of 21 MMRCDS subgroup patients and 12 of 16 in the MBDS subgroup. Across all patients, VFA or medialization laryngoplasty had no overall effect on dyspnea. Limitations included potential dataset bias and lack of a tool to quantify dyspnea related to upper airway dysfunction.
Citation: Dion GR, Fritz MA, Teng SE, et al. Impact of vocal fold augmentation and laryngoplasty on dyspnea in patients with glottal incompetence. Laryngoscope. 2018;128:427–429