Introduction: Glottic insufficiency which is inability to obtain complete vocal fold approximation during phonation is a common cause for dysphonia. Vocal fold immobility, vocal fold sulcus, presbylaryngis, vocal fold scarring are common causes.
Materials and methods: We have studied 30 cases of glottic insufficiency that failed conservative management and underwent surgical intervention. Voice parameters like maximal phonation time (MPT) and voice handicap index (VHI) have been used as assessment parameters along with laryngoscopic examination.
Observations and results: Twenty-one cases had vocal fold immobility, while the rest had vocal sulcus (7), vocal fold atrophy (1), vocal fold scarring (1) as the cause. All cases presented with voice change with few having symptoms of aspiration. Patients were subjected to either vocal fold injection or medialization thyroplasty depending on the etiology and severity, and the outcomes assessed. Majority of our cases showed good amount of improvement on videolaryngoscopy and voice analysis (MPT, VHI scores). Mean MPT scores improved from 7.57 seconds (pre-operative) to 18.83 seconds (final post-operative) and VHI scores changed from a mean of 49.6 to 26.57. Few had post operative problems like vocal fold oedema, under correction, implant malposition. Four patients needed revision procedures due to suboptimal results.
Conclusion: Selection of the most suitable procedure for each patient, meticulous and precise technique and adequate follow up will promise best results and minimize complications and undesired results in patients of glottic insufficiency.
Revis J, Robieux C, Ghio A, Giovanni A.Rev Laryngol Otol Rhinol (Bord). Social consequence of a dysphonic voice, design and validation of a questionnaire and first results. 2013; 134(1):35-41. French.
Clark A. Rosen, Hans Leden, Robert H. Ossoff, Blake Simpson, Operative Techniques in Laryngology. Operative Techniques in Laryngology, introduction to glottic insufficiency. chapter 5.1
Jacobson BH, Jhonson A, Grywalski C, Silbergleit A, Jacobson G, Benninger M, et al. The voice handicap index. Development and validation. Am J Speech Lang Pathol. 1997; 6: 66-70.
Omori K. Outline of voice disorders and examination methods. The Japan Society of Logopedics and Phoniatrics. Edition- Voice Examination methods. Tokyo. Ishiyaku Publishers 2009: 36-54.
Rajaei A, Ebrahim BB, Fariba M, Mohammad HN. The occurrence of Laryngeal Penetration and Aspiration in patients with Glottal Closure Insufficincy. ISRN Otolaryngology. Vol 2014, Article ID: 557945,5.
Clark A. Rosen, Hans Leden, Robert H. Ossoff, Blake Simpson, Operative Techniques in Laryngology. Principals of vocal fold augmentation. chapter 14: 91-95.
Clark A. Rosen, Hans Leden, Robert H. Ossoff, Blake Simpson, Operative Techniques in Laryngology. Principals of laryngeal framework surgery. chapter 31: 231-234.
Chrobok V, Pellant A, Sram F, Fric M, Praisler J, Prymula R, Svec JG. Medialization thyroplasty with a customized silicone implant: Clinical Experience. Pubmed.
Kanishka C, Somnath S, Vedula P S, Sudipta P, Indranil C. Pre and Post Operative voice analysis after medialization thyroplasty in cases of unilateral vocal fold paralysis. Indian J Otolaryngol Head Neck surgery. 2013 December; 65(4): 354-357.
Virgilijus U, Ruta P, Viktoras S. Multidimensional assessment of functional outcomes of medialization thyroplasty. Eur Arch Otorhinolaryngol (2005) 262; 616-621.
Anoop Raj, Manish Girhotra, Ravi Meher. Medialization Laryngoplasty- A Study of 15 Cases. Indian Journal of Otolaryngology and Head & Neck Surgery. Vol 56 No. 4, Oct-Dec 2004.
Yung KC, Likhterov I. Courey MS. Effect of temporary vocal fold injection on the rate of permanent medialization laryngoplasty in unilateral vocal cord paralysis patients. Laryngoscope 10/2011; 121(10): 2191-2194.
Tucker HM, Wanamaker J, Trott M, Hicks D. Complications of Laryngeal Framework Surgery (Phonosurgery). Laryngoscope 1993;103, 525-528