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Impact of Pulmonary Function on Voice Outcomes After Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

  • Changhee Lee
    Affiliations
    Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Younghac Kim
    Affiliations
    Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Yujin Heo
    Affiliations
    Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Tae Hwan Kim
    Affiliations
    Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Heejun Yi
    Affiliations
    Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Nayeon Choi
    Correspondence
    Address correspondence and reprint requests to Nayeon Choi, Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
    Affiliations
    Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Young-Ik Son
    Affiliations
    Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Published:September 19, 2022DOI:https://doi.org/10.1016/j.jvoice.2022.06.019

      Summary

      Objectives

      Pulmonary function is closely associated with voice quality especially in patients with voice disorder including unilateral vocal fold paralysis (UVFP). Injection laryngoplasty (IL) is the standard treatment for patients with UVFP. We investigated the subjective and objective voice outcomes according to pulmonary function test (PFT) before IL in patients with UVFP.

      Method

      We retrospectively analyzed the patients who underwent IL for UVFP between 2004 and 2021 (N = 1201), and finally investigated 261 patients with PFT results before IL. The patients were classified into three groups according to results of PFT: normal (n = 189, 72%), mild (n = 40, 15%), and moderate (n = 32, 13%) obstructive pattern. Aspiration symptoms and subjective and objective voice parameters of voice handicap index (VHI), GRBAS score, maximal phonation time (MPT), Jitter, Shimmer, and noise to harmonic ratio (NHR) were compared between normal and abnormal (mild or moderate obstructive pattern) PFT groups.

      Results

      Age (68.0 ± 9.1 and 61.2 ± 12.6, respectively) was significantly higher and males were more common (84.7% and 57.7%, respectively) in abnormal PFT than in normal PFT. Aspiration showed significant improvement in all groups. The subjective and objective voice parameters significantly improved after IL in normal and mild obstruction groups, but MPT, Shimmer, and VHI did not significantly improve in the moderate obstruction group. The improvement in VHI-30 after IL was significantly higher in the normal group (20.0 ± 29.5) than in the mild (10.3 ± 32.8) or moderate (9.9 ± 33.2) obstruction group (P = 0.035). Improved amounts of MPT, Jitter, Shimmer, and NHR were not significantly different among the groups, but improvement of VHI was smallest in the moderate obstructive pattern group.

      Conclusion

      Voice parameters showed significant improvement after IL in both normal and mild obstructive pattern groups, but MPT and VHI did not significantly improve in the moderate obstructive pattern group. In addition, patients with normal pulmonary function had marked improvement of subjective symptoms after IL in comparison with patients with abnormal pulmonary function.

      Key Words

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      REFERENCES

        • Hassan MM
        • Hussein MT
        • Emam AM
        • et al.
        Is insufficient pulmonary air support the cause of dysphonia in chronic obstructive pulmonary disease?.
        Auris Nasus Larynx. 2018; 45: 807-814
        • Santos KW
        • Echeveste SS
        • Vidor DC.
        Association between lung function and vocal affections arising from tobacco consumption.
        Int Arch Otorhinolaryngol. 2014; 18: 11-15
        • Benninger MS
        • Crumley RL
        • Ford CN
        • et al.
        Evaluation and treatment of the unilateral paralyzed vocal fold.
        Otolaryngol Head Neck Surg. 1994; 111: 497-508
        • Brunner E
        • Friedrich G
        • Kiesler K
        • et al.
        Subjective breathing impairment in unilateral vocal fold paralysis.
        Folia Phoniatr Logop. 2011; 63: 142-146
        • Kwon TK
        • Buckmire R.
        Injection laryngoplasty for management of unilateral vocal fold paralysis.
        Curr Opin Otolaryngol Head Neck Surg. 2004; 12: 538-542
        • Pei YC
        • Chuang HF
        • Wong AMK
        • et al.
        Voice aerodynamics following office-based hyaluronate injection laryngoplasty.
        Clin Otolaryngol. 2019; 44: 594-602
        • Wolfe V
        • Fitch J
        • Martin D.
        Acoustic measures of dysphonic severity across and within voice types.
        Folia Phoniatr Logop. 1997; 49: 292-299
        • Ranu H
        • Wilde M
        • Madden B.
        Pulmonary function tests.
        Ulster Med J. 2011; 80: 84-90
        • Choi N
        • Jin H
        • Kim HJ
        • et al.
        Early injection laryngoplasty with a long-lasting material in patients with potentially recoverable unilateral vocal fold paralysis.
        Clin Exp Otorhinolaryngol. 2019; 12: 427-432
        • Al-Jazeeri I
        • Al-Jazeeri H
        Factors affecting outcomes of injection laryngoplasty: a systematic review.
        Saudi J Otorhinolaryngol Head Neck Surg. 2020; 22: 1-6
        • Elsaeed A
        • Afsah O
        • Moneir W
        • et al.
        Respiratory and voice outcomes of office-based injection laryngoplasty in patients with unilateral vocal fold paralysis.
        Egypt J Otolaryngol. 2021; 37: 1
        • Fang TJ
        • Hsin LJ
        • Chung HF
        • et al.
        Office-based intracordal hyaluronate injections improve quality of life in thoracic-surgery-related unilateral vocal fold paralysis.
        Medicine (Baltimore). 2015; 94: e1787
        • Mor N
        • Wu G
        • Aylward A
        • et al.
        Predictors for permanent medialization laryngoplasty in unilateral vocal fold paralysis.
        Otolaryngol Head Neck Surg. 2016; 155: 443-453
        • Woo SH
        • Son YI
        • Lee SH
        • et al.
        Comparative analysis on the efficiency of the injection laryngoplasty technique using calcium hydroxyapatite (CaHA): the thyrohyoid approach versus the cricothyroid approach.
        J Voice. 2013; 27: 236-241
        • Chang J
        • Courey MS
        • Al-Jurf SA
        • et al.
        Injection laryngoplasty outcomes in irradiated and nonirradiated unilateral vocal fold paralysis.
        Laryngoscope. 2014; 124: 1895-1899
        • Sardesai MG
        • Merati AL
        • Hu A
        • et al.
        Impact of patient-related factors on the outcomes of office-based injection laryngoplasty.
        Laryngoscope. 2016; 126: 1806-1809
        • Demir M
        • Paksoy M
        • Şanlı A
        • et al.
        Subjective and objective evaluation of voice and pulmonary function in partial laryngectomised patients.
        Integr Cancer Sci Ther. 2016; 3: 349-353
        • Bielamowicz S
        • Stager SV.
        Diagnosis of unilateral recurrent laryngeal nerve paralysis: laryngeal electromyography, subjective rating scales, acoustic and aerodynamic measures.
        Laryngoscope. 2006; 116: 359-364
        • Netsell R
        • Lotz W
        • Shaughnessy AL.
        Laryngeal aerodynamics associated with selected voice disorders.
        Am J Otolaryngol. 1984; 5: 397-403
        • Iwarsson J
        • Sundberg J.
        Effects of lung volume on vertical larynx position during phonation.
        J Voice. 1998; 12: 159-165
        • Jain NK
        • Thakkar MS
        • Jain N
        • et al.
        Chronic obstructive pulmonary disease: does gender really matter?.
        Lung India. 2011; 28: 258-262
        • Gasperino J.
        Gender is a risk factor for lung cancer.
        Med Hypotheses. 2011; 76: 328-331
        • Park JP
        • Jeong G-E
        • Kang BC
        • et al.
        Usefulness of S/Z ratio and maximum phonation time in unilateral vocal fold paralysis with decreased pulmonary function.
        J Korean Soc Laryngol Phoniatr Logop. 2012; 23: 129-132
        • Lowell SY
        • Barkmeier-Kraemer JM
        • Hoit JD
        • et al.
        Respiratory and laryngeal function during spontaneous speaking in teachers with voice disorders.
        J Speech Lang Hear Res. 2008; 51: 333-349
        • Hunter EJ
        • Maxfield L
        • Graetzer S.
        The effect of pulmonary function on the incidence of vocal fatigue among teachers.
        J Voice. 2020; 34: 539-546
        • Bell D
        • Layton AJ
        • Gabbay J.
        Use of a guideline based questionnaire to audit hospital care of acute asthma.
        BMJ. 1991; 302: 1440-1443