Department of Otolaryngology-Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, Alabama, USA.
Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
Otolaryngol Head Neck Surg. 2022 Aug;167(2):327-333. doi: 10.1177/01945998211056515. Epub 2021 Nov 9.
Patients with unilateral vocal fold paralysis commonly report dysphonia and dysphagia. Dyspnea also occurs, with studies on treatment-related change producing mixed results. Studies including patient-reported outcomes have focused on single-question global scales. The Dyspnea Index (DI) includes 10 questions, is specific to upper airway-related dyspnea, and may better capture these patients' symptoms. We evaluated change in DI after treatment.
Retrospective review.
Academic medical center.
Forty-three patients with unilateral vocal fold paralysis underwent injection augmentation (n = 25) or framework surgery (n = 18). DI was recorded preprocedure, 2 to 4 weeks afterward, and at approximately 3 months afterward in 19 patients. Voice Handicap Index-10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool-10 were also recorded. Change in parameters and correlations were assessed. Obesity, cardiac disease, pulmonary disease, and procedure (injection vs framework surgery) were evaluated for effect on DI.
Twenty-four patients had an abnormal baseline DI (>10). DI decreased from 14.9 ± 13.8 to 6.5 ± 9.3 after treatment ( < .001; 95% CI, 4.7-12.1). Twenty-eight scores decreased, 9 remained unchanged, and 6 increased. Change in DI was influenced by the presence of cardiac disease. Decreased DI persisted at 3-month follow-up. Voice Handicap Index-10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool-10 scores decreased and were correlated with change in DI.
Upper airway-related dyspnea is common in unilateral vocal fold paralysis, occurring in half of this cohort. Correcting glottic insufficiency may alleviate symptoms. Treatment decision making should consider postprocedural change in dyspnea, especially in patients for whom dyspnea is a motivating factor for seeking treatment.
单侧声带麻痹患者常报告声音嘶哑和吞咽困难。也会出现呼吸困难，而关于治疗相关变化的研究结果不一。包括患者报告的结果在内的研究侧重于单问题的全球量表。呼吸困难指数（DI）包括 10 个问题，专门针对上气道相关呼吸困难，可能更好地捕捉这些患者的症状。我们评估了治疗后 DI 的变化。
回顾性研究。
学术医疗中心。
43 例单侧声带麻痹患者接受注射增强（n = 25）或框架手术（n = 18）。19 例患者在术前、术后 2 至 4 周以及术后约 3 个月记录 DI。还记录了嗓音障碍指数 10 分、声门功能指数、咳嗽严重程度指数和饮食评估工具 10 分。评估了参数的变化和相关性。评估了肥胖、心脏病、肺病和手术（注射与框架手术）对 DI 的影响。
24 例患者基线 DI 异常（>10）。治疗后 DI 从 14.9 ± 13.8 降至 6.5 ± 9.3（<0.001；95%CI，4.7-12.1）。28 个分数下降，9 个分数不变，6 个分数增加。DI 的变化受心脏病的影响。3 个月随访时 DI 持续下降。嗓音障碍指数 10 分、声门功能指数、咳嗽严重程度指数和饮食评估工具 10 分下降，与 DI 的变化相关。
单侧声带麻痹患者常出现上气道相关呼吸困难，本队列中有一半患者存在这种情况。纠正声门不全可能缓解症状。治疗决策应考虑呼吸困难的术后变化，尤其是对呼吸困难是寻求治疗的动机因素的患者。
