McLaughlin Conor W, Swendseid Brian, Courey Mark S, Schneider Sarah, Gartner-Schmidt Jackie L, Yung Katherine C
Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A.
Department of General Surgery, University of California San Francisco, San Francisco, California, U.S.A.
Laryngoscope. 2018 Feb;128(2):430-436. doi: 10.1002/lary.26900. Epub 2017 Nov 24.
OBJECTIVES/HYPOTHESIS: At presentation, unilateral vocal fold paralysis (UVFP) patients have different treatment options, including conservative management (CM), injection laryngoplasty (IL) with a temporary agent, or permanent medialization (PM). This study evaluates long-term outcomes for UVFP patients relative to intervention.
Retrospective chart review.
A retrospective chart review was performed of UVFP patients who presented to the University of California San Francisco Voice and Swallowing Center. Videolaryngostroboscopy examinations were reviewed. Maximum glottic closure was quantified with the normalized glottic gap area (NGGA). Perceptual voice analysis was performed using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) at corresponding time points.
Fifty-three patients met inclusion criteria. Six underwent CM only, 20 went on to require PM, 19 underwent IL only, and eight underwent IL and subsequent PM. NGGA at presentation was similar among groups; however, the CM group was noted to have more favorable CAPE-V scores for Breathiness (P = .007) and Loudness (P = .018). All groups had similar NGGA and CAPE-V scores at last follow-up. When compared to pooled data for patients who underwent PM, the IL group was noted to have similar NGGA and CAPE-V scores at presentation. Although improvements in both groups were noted following intervention, both groups appeared similar at last follow-up with the exception of Roughness, for which the IL group retained a slightly improved outcome (13.3 vs. 18.3, P = .03).
At presentation, UVFP patients have similar NGGA. This finding suggests that treatment recommendations cannot be made on the size of the glottic gap alone. Furthermore, in many patients, IL results in long-term benefit with glottic closure and CAPE-V scores equivalent to that obtained with PM.
目的/假设:初诊时,单侧声带麻痹(UVFP)患者有不同的治疗选择,包括保守治疗(CM)、使用临时药物的注射喉成形术(IL)或永久性声带内移术(PM)。本研究评估UVFP患者相对于干预措施的长期疗效。
回顾性病历审查。
对就诊于加利福尼亚大学旧金山分校嗓音与吞咽中心的UVFP患者进行回顾性病历审查。对电子喉镜频闪检查进行回顾。用标准化声门间隙面积(NGGA)对最大声门闭合进行量化。在相应时间点使用嗓音共识听觉-感知评估(CAPE-V)进行感知性嗓音分析。
53例患者符合纳入标准。6例仅接受CM,20例随后需要PM,19例仅接受IL,8例接受IL及随后的PM。初诊时各组的NGGA相似;然而,CM组在呼吸音(P = 0.007)和响度(P = 0.018)方面的CAPE-V评分更优。最后一次随访时所有组的NGGA和CAPE-V评分相似。与接受PM的患者汇总数据相比,IL组初诊时的NGGA和CAPE-V评分相似。尽管两组在干预后均有改善,但除粗糙音外,两组在最后一次随访时表现相似,IL组在粗糙音方面的结果略有改善(13.3对18.3,P = 0.03)。
初诊时,UVFP患者的NGGA相似。这一发现表明,不能仅根据声门间隙大小来做出治疗建议。此外,在许多患者中,IL能带来长期益处,声门闭合及CAPE-V评分与PM相当。
4。《喉镜》,2018年,第128卷,第430 - 436页。