Literature Review: A Roundup of Important Recent Studies

—Reviewed by Amy Eckner

Type I GPT Improves Vocal Outcomes in GI

How effective is type I Gore-Tex thyroplasty (GTP), when used by itself, on patients with nonparalytic glottic incompetence (GI)?

Background: GI encompasses a variety of laryngeal pathologies. Type I (medialization) thyroplasty has long been considered the procedure of choice for surgical treatment of GI resulting from vocal fold paralysis/immobility. Although both injection laryngoplasty and type I thyroplasty have been used to treat GI in patients with mobile folds, reliable, comparable vocal outcomes data in this varied patient population remain limited.

Study design: Retrospective review consisting of a subgroup analysis of validated, subjective and perceptual voice outcome measures (voice-related quality of life [VRQOL], Glottal Function Index [GFI] and GRBAS [grade, roughness, breathiness, asthenia, and strain]) after GTP in patients with vocal fold paresis (VFP), hypomobility, scar and atrophy.

Setting: University of North Carolina Voice Center, Chapel Hill.

Synopsis: Forty-eight patients with nonparalytic GI treated with GTP were reviewed. Patients were grouped according to primary diagnosis: VFP (12), hypomobility (20), scar (7) and atrophy (9). Twenty patients underwent bilateral type I GTP, and 28 were unilateral. Median follow-up time was 11 months. The median post-GTP increase in VRQOL for the entire surgical cohort was 30 points and was significant for each subgroup as well. The median decrease in GFI for the entire surgical cohort was seven points. Several subgroups also showed significantly improved post-operative GFI scores, including hypomobility and VFP. The median decrease in GRBAS was two points for the entire group. All subgroups (except scar) showed significant improvements in perceptual scoring. Post-thyroplasty increases in VRQOL had a moderate correlation with post-thyroplasty decreases in GFI.

Bottom line: Patients with nonparalytic GI, particularly those with vocal fold hypomobility, showed improved subjective and perceptual measures following GTP.

Citation: Shah RN, Deal AM, Buckmire RA. Multidimensional voice outcomes after type I Gore-Tex thyroplasty in patients with nonparalytic glottic incompetence: a subgroup analysis. Laryngoscope. 2013;123:1742-1745.

—Reviewed by Amy Eckner