PDF(Pubmed)
Abstract：
OBJECTIVE: Arytenoid adduction as an addition to medialisation thyroplasty is highly advocated by some surgeons in selected cases but deemed less necessary by others in patients with unilateral vocal fold paralysis. This study aims to evaluate the additional benefits on voice outcome of arytenoid adduction in patients with unilateral vocal fold paralysis undergoing medialisation thyroplasty using intra-operative voice measurements.
METHODS: A prospective study was conducted. Voice audio recordings were obtained at 4 moments; 1. direct prior to the start of surgery, 2. during surgery after medialisation thyroplasty, 3. during surgery after medialisation and arytenoid adduction, 3 months postoperative. At these same timepoints patients rated their own voice on a numeric rating scale between 0 and 10. The blinded recordings were rated by consensus in a team of experienced listeners, using the Grade of the GRBAS scale. Furthermore, the Voice Handicap Index was administered before and at 3 months after surgery.
RESULTS: Ten patients who underwent medialisation and arytenoid adduction at our tertiary referral hospital between 2021 and 2022, were included. One patient was excluded after surgery. The intraoperative measurements showed a Grade score of 1.4 preoperatively, improving to 1.2 after medialisation, 1.2 after medialisation and arytenoid adduction, and further improving to 0.4 at 3 months postoperative, which was a not statistically significant improvement (p = 0.2). The intraoperative subjective numeric rating scale showed a statistically significant improvement from 3.9 preoperatively, to 6.1 after medialisation, 7.1 after medialisation and arytenoid adduction and a 7.6 at 3 months postoperative (p = 0.001). The Voice Handicap Index total score showed a statistically significant improvement from 71 points before surgery to 13 at 3 months after surgery (p = 0.008).
CONCLUSIONS: Our study using intraoperative voice measurements indicate that the addition of arytenoid adduction to medialisation thyroplasty is a benefit in selected patients although more studies are needed due to the many limitations inherent to this field of investigation.
METHODS: A prospective study was conducted. Voice audio recordings were obtained at 4 moments; 1. direct prior to the start of surgery, 2. during surgery after medialisation thyroplasty, 3. during surgery after medialisation and arytenoid adduction, 3 months postoperative. At these same timepoints patients rated their own voice on a numeric rating scale between 0 and 10. The blinded recordings were rated by consensus in a team of experienced listeners, using the Grade of the GRBAS scale. Furthermore, the Voice Handicap Index was administered before and at 3 months after surgery.
RESULTS: Ten patients who underwent medialisation and arytenoid adduction at our tertiary referral hospital between 2021 and 2022, were included. One patient was excluded after surgery. The intraoperative measurements showed a Grade score of 1.4 preoperatively, improving to 1.2 after medialisation, 1.2 after medialisation and arytenoid adduction, and further improving to 0.4 at 3 months postoperative, which was a not statistically significant improvement (p = 0.2). The intraoperative subjective numeric rating scale showed a statistically significant improvement from 3.9 preoperatively, to 6.1 after medialisation, 7.1 after medialisation and arytenoid adduction and a 7.6 at 3 months postoperative (p = 0.001). The Voice Handicap Index total score showed a statistically significant improvement from 71 points before surgery to 13 at 3 months after surgery (p = 0.008).
CONCLUSIONS: Our study using intraoperative voice measurements indicate that the addition of arytenoid adduction to medialisation thyroplasty is a benefit in selected patients although more studies are needed due to the many limitations inherent to this field of investigation.
摘要：
目的：在选定的病例中，一些外科医生极力主张将Arytenoid内收作为甲状腺成形术的补充，但在单侧声带麻痹患者中，其他人则认为不必要。这项研究旨在通过术中语音测量来评估单侧声带麻痹患者接受甲状腺修复术的声带内收对语音结果的额外益处。
方法：进行前瞻性研究。在4时刻获得语音录音;1.在手术开始之前，2.在甲状腺中介成形术后的手术过程中，3.在手术后的中介和arytenoid内收，术后3个月。在这些相同的时间点，患者在0到10之间的数字评定量表上对自己的声音进行评分。盲目的录音在一组经验丰富的听众中得到了一致的评价，使用GRBAS量表的等级。此外，在手术前和手术后3个月时使用语音障碍指数.
结果：纳入了在2021年至2022年期间在我们的三级转诊医院接受了中介化和Arytenoid内收的10例患者。一名患者在手术后被排除在外。术中测量显示术前评分为1.4，调解后提高到1.2，1.2在中介化和arytenoid内收之后，术后3个月进一步改善至0.4，无统计学意义的改善（p=0.2）。术中主观数字评定量表显示与术前3.9相比有统计学上的显着改善，到6.1，在调解后，7．1个月后，在3个月后为7.6（p=0.001）。语音障碍指数总分显示，从手术前的71分到手术后3个月的13分，具有统计学意义（p=0.008）。
结论：我们使用术中语音测量进行的研究表明，尽管由于该研究领域固有的许多局限性，需要进行更多的研究，但在选定的患者中，在中介甲状腺成形术中添加类软骨内收是有益的。
方法：进行前瞻性研究。在4时刻获得语音录音;1.在手术开始之前，2.在甲状腺中介成形术后的手术过程中，3.在手术后的中介和arytenoid内收，术后3个月。在这些相同的时间点，患者在0到10之间的数字评定量表上对自己的声音进行评分。盲目的录音在一组经验丰富的听众中得到了一致的评价，使用GRBAS量表的等级。此外，在手术前和手术后3个月时使用语音障碍指数.
结果：纳入了在2021年至2022年期间在我们的三级转诊医院接受了中介化和Arytenoid内收的10例患者。一名患者在手术后被排除在外。术中测量显示术前评分为1.4，调解后提高到1.2，1.2在中介化和arytenoid内收之后，术后3个月进一步改善至0.4，无统计学意义的改善（p=0.2）。术中主观数字评定量表显示与术前3.9相比有统计学上的显着改善，到6.1，在调解后，7．1个月后，在3个月后为7.6（p=0.001）。语音障碍指数总分显示，从手术前的71分到手术后3个月的13分，具有统计学意义（p=0.008）。
结论：我们使用术中语音测量进行的研究表明，尽管由于该研究领域固有的许多局限性，需要进行更多的研究，但在选定的患者中，在中介甲状腺成形术中添加类软骨内收是有益的。
