Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Eur Arch Otorhinolaryngol. 2022 Apr;279(4):1995-2002. doi: 10.1007/s00405-021-07199-1. Epub 2021 Dec 2.
Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept.
61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich's Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL.
All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level.
EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure-therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.
内镜杓状软骨外侧移位固定术（EAAL）是一种可靠的手术方法，可用于微创治疗双侧声带麻痹（BVFP），通过简单的缝线将杓状软骨向外侧移位，从而稳定气道。这种干预方式具有非破坏性，理论上会导致更高的再生潜力，从而改善嗓音质量。本研究旨在探讨该治疗理念的呼吸和发声效果。
61 例因甲状腺/甲状旁腺手术而出现明显呼吸困难的 BVFP 患者接受单侧 EAAL 治疗。18 个月后，评估患者的颤音、抖动、谐噪比、最长发声时间、基频、嗓音障碍指数、嗓音严重程度指数、Friedrich 嗓音障碍指数、总体粗糙声呼吸声计测值、生活质量和吸气峰流速。
所有患者在随访期间均保持稳定且充足的气道。10 例（16.4%）患者双侧运动完全恢复，客观声学参数处于生理范围内。13 例（21.3%）单侧恢复患者的大多数功能结果也达到正常水平。15 例（24.6%）仅单侧内收恢复，嗓音质量略有受损。11 例（18.0%）仅出现假声带发音，但声音具有社会可接受性。12 例（19.7%）患者在声门上水平未检测到明显的运动恢复。
EAAL 不会干扰潜在的再生过程，满足了最重要的语音学要求，同时保证了手术的可逆转性——因此适用于暂时性麻痹的患者。此外，即使在双侧声带永久性麻痹的情况下，也能确保患者获得具有社会可接受性的嗓音质量和充足的气道。
