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Anales de Otorrinolaringología Mexicana

2016, Number 4

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Otorrinolaringología 2016; 61 (4)

Voice acoustic analysis in patients with bilateral vocal fold paralysis treated by CO2 laser posterior cordotomy

Tona-Acedo G, Góngora-Cadena G, González-González AI, González-Garza IM

Language: Spanish
References: 50
Page: 255-262
PDF size: 362.45 Kb.


ABSTRACT

Background: Causes of bilateral vocal fold paralysis are local, neurological, iatrogenic, neoplastic or idiopathic, causing important respiratory restriction and dysphonia. CO2 laser posterior cordotomy is considered a decisive treatment for this disease, by functional satisfactory results. In different measure it can drive to a significant deterioration of the voice, in spite of restored respiratory function, this factor is determinant in the quality of life of patients.
Objetive: To determine the vocal characteristics associated with CO2 laser posterior cordotomy in patients with bilateral vocal fold paralysis by acoustic analysis of voice previous and 6 months after the procedure.
Material and Method: A prospective study was made in which computed record of voice was made with the software Sona-Speech II Real Time Pitch and MDVP.
Results: Nine patients were included, 8 women, with an average age of 42.1 years. In 55.5% total thyroidectomy was the most frequent cause of the disease. We were able to decannulate 60% of the patients with tracheotomy. In the acoustic analysis of voice, tone, intensity, fundamental frequency, vocal range, jitter, shimmer, harmonics to noise ratio and maximum phonation time did not have statistically significant difference. Statistically significant result was the number of harmonic (p=0.008, t Student).
Conclusion: CO2 laser posterior cordotomy is a procedure that allows to preserve the characteristics of voice with variations in the harmonics, clinically this can produce an opaque voice, which has lost color and wealth.


REFERENCES

  1. Myssiorek D. Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am 2004;37:25-44.

  2. Zealear LD. Neurophysiology of vocal fold paralysis. Otolaryngol Clin North Am 2004;37:1-23.

  3. Sataloff TR. Vocal fold paresia and paralysis. Otolaryngol Clin N Am 2007;40:1109-1131.

  4. Sinacori JT. Unilateral and bilateral vocal fold paralysis: techniques and controversies in management. Curr Opin Otolaryngol Head Neck Surg 2002;10:472-477.

  5. Harnisch W. Breathing and voice quality after surgical treatment for lateral vocal cord paralysis. Arch Otolaryngol Head Neck Surg 2008;134:278-284.

  6. Crumley RL. Endoscopic laser medial arytenoidectomy for airway management in bilateral laryngeal paralysis. Ann Otol Rhinol Laryngol 1993;102:81-84.

  7. Kashima HK. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol 1991;100:717-721.

  8. Manolopuos L, Stavroulaki P. CO2 and KTP-532 laser cordectomy for bilateral vocal fold paralysis. J Laryngol Otol 1999;113:637-641.

  9. Dursun G. Aerodynamic, acoustic and functional results of posterior transverse laser cordotomy for bilateral abductor vocal fold paralysis. J Laryngol Otol 2006;120:282-288.

  10. Bajaj Y. Vocal fold paralysis: role of bilateral transverse cordotomy. J Laryngol Otol 2009;122:1348-1351.

  11. Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatmen of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1989;98:930-934.

  12. Shvero J, Koren R. Laser posterior ventriculocordectomy with partial arytenoidectomy for the treatment of bilateral vocal fold immobility. J Laryngol Otol 2003;117:540-543.

  13. Shindo M, Chheda N. Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 2007;133:481-485.

  14. Hillel DA, et al. Evaluation and management of bilateral vocal cord immobility. Otolaryngol Head Neck Surg 1999;121:760-765.

  15. Gardner G. Posterior glottic stenosis and bilateral vocal fold immobility diagnosis and treatment. Otolaryngol Clin N Am 2000;33.

  16. Tucker HM. Vocal cord paralysis -1979: etiology and management. Laryngoscope 1980;90:585-590.

  17. Bosley B, Rosen CA. Medial arytenoidectomy versus transverse cordotomy as a treatment for bilateral vocal fold paralysis. Ann Otol Rhinol Laryngol 2005;114:922-926.

  18. Young N, Rosen A. Arytenoid and posterior vocal fold surgery for bilateral vocal fold immobility. Curr Opin Otolaryngol Head Neck Surg 2011;19:422-427.

  19. Oswal VH, et al. Endoscopic laser management of bilateral abductor palsy. Indian J Otolaryngol Head Neck Surg 2009;61:47-51.

  20. Rosenthal LH, Benninger MS, Deeb RH. Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 2007;117:1864-1870.

  21. Mohamed NN, et al. Comparison between laser- and diathermy- assisted posterior cordotomy for bilateral vocal cord abductor paralysis. JAMA Otolaryngol Head Neck Surg 2013;139:923-930.

  22. Hans S, et al. Aerodynamic and acoustic parameters in CO2 laser posterior transverse cordotomy for bilateral vocal fold paralysis. Acta Otolaryngol 2000;120:330-335.

  23. Señaris GB. Indice de Incapacidad Vocal: factores predictivos. Acta Otorrinolaringol Esp 2006;57:101-108.

  24. González J. Análisis acústico de la voz: fiabilidad de un conjunto de parámetros multidimensionales. Acta Otorrinolaringol Esp 2002;53:256-268.

  25. Olthoff A, et al. Laser microsurgery bilateral posterior cordectomy for the treatment of bilateral vocal fold paralysis. An Otol Rhin Laryngol 2005;114:599-604.

  26. Myssiorek D. Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am 2004;37:25-44.

  27. Zealear LD. Neurophysiology of vocal fold paralysis. Otolaryngol Clin North Am 2004;37:1-23.

  28. Sataloff TR. Vocal fold paresia and paralysis. Otolaryngol Clin N Am 2007;40:1109-1131.

  29. Sinacori JT. Unilateral and bilateral vocal fold paralysis: techniques and controversies in management. Curr Opin Otolaryngol Head Neck Surg 2002;10:472-477.

  30. Harnisch W. Breathing and voice quality after surgical treatment for lateral vocal cord paralysis. Arch Otolaryngol Head Neck Surg 2008;134:278-284.

  31. Crumley RL. Endoscopic laser medial arytenoidectomy for airway management in bilateral laryngeal paralysis. Ann Otol Rhinol Laryngol 1993;102:81-84.

  32. Kashima HK. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol 1991;100:717-721.

  33. Manolopuos L, Stavroulaki P. CO2 and KTP-532 laser cordectomy for bilateral vocal fold paralysis. J Laryngol Otol 1999;113:637-641.

  34. Dursun G. Aerodynamic, acoustic and functional results of posterior transverse laser cordotomy for bilateral abductor vocal fold paralysis. J Laryngol Otol 2006;120:282-288.

  35. Bajaj Y. Vocal fold paralysis: role of bilateral transverse cordotomy. J Laryngol Otol 2009;122:1348-1351.

  36. Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatmen of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1989;98:930-934.

  37. Shvero J, Koren R. Laser posterior ventriculocordectomy with partial arytenoidectomy for the treatment of bilateral vocal fold immobility. J Laryngol Otol 2003;117:540-543.

  38. Shindo M, Chheda N. Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 2007;133:481-485.

  39. Hillel DA, et al. Evaluation and management of bilateral vocal cord immobility. Otolaryngol Head Neck Surg 1999;121:760-765.

  40. Gardner G. Posterior glottic stenosis and bilateral vocal fold immobility diagnosis and treatment. Otolaryngol Clin N Am 2000;33.

  41. Tucker HM. Vocal cord paralysis -1979: etiology and management. Laryngoscope 1980;90:585-590.

  42. Bosley B, Rosen CA. Medial arytenoidectomy versus transverse cordotomy as a treatment for bilateral vocal fold paralysis. Ann Otol Rhinol Laryngol 2005;114:922-926.

  43. Young N, Rosen A. Arytenoid and posterior vocal fold surgery for bilateral vocal fold immobility. Curr Opin Otolaryngol Head Neck Surg 2011;19:422-427.

  44. Oswal VH, et al. Endoscopic laser management of bilateral abductor palsy. Indian J Otolaryngol Head Neck Surg 2009;61:47-51.

  45. Rosenthal LH, Benninger MS, Deeb RH. Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 2007;117:1864-1870.

  46. Mohamed NN, et al. Comparison between laser- and diathermy- assisted posterior cordotomy for bilateral vocal cord abductor paralysis. JAMA Otolaryngol Head Neck Surg 2013;139:923-930.

  47. Hans S, et al. Aerodynamic and acoustic parameters in CO2 laser posterior transverse cordotomy for bilateral vocal fold paralysis. Acta Otolaryngol 2000;120:330-335.

  48. Señaris GB. Indice de Incapacidad Vocal: factores predictivos. Acta Otorrinolaringol Esp 2006;57:101-108.

  49. González J. Análisis acústico de la voz: fiabilidad de un conjunto de parámetros multidimensionales. Acta Otorrinolaringol Esp 2002;53:256-268.

  50. Olthoff A, et al. Laser microsurgery bilateral posterior cordectomy for the treatment of bilateral vocal fold paralysis. An Otol Rhin Laryngol 2005;114:599-604.




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