Enhancing Voice and Swallowing: A Cross-Sectional Study on Percutaneous Injection Medialisation Laryngoplasty Outcomes in Patients of Unilateral Vocal Cord Palsy.

Abstract

Unilateral vocal cord palsy (UVCP) is a condition that significantly impacts voice quality and swallowing function, leading to considerable challenges in communication and nutrition. Percutaneous Injection Medialisation laryngoplasty (PIML) has emerged as a pivotal intervention to restore vocal cord function in affected patients. To evaluate the vocal and swallowing outcomes in cases of unilateral vocal cord palsy by PIML based on vocal and swallowing parameters. A cross-sectional analytical study was conducted at tertiary care hospital among 40 adult patients of UVCP without structural lesion of larynx and were treated with PIML using hyaluronic acid. Vocal and swallowing parameters were measured prior to procedure and post procedure at 2 h, 3 month and 6 month. Subjective parameter like VHI-30 and objective parameters were measured by using (1) Acoustic analysis (2) Perceptual Evaluation by GRBAS, (3) Aerodynamic analysis by Mean phonation time (MPT). Swallowing outcome measured by using Penetration-Aspiration scale (PAS) on Functional Endoscopic Evaluation of Swallowing (FEES). 40 patients with UVCP treated with injection laryngoplasty under LA. There was significant decrease in VHI (by 32.05 points, p < 0.05), GRBAS (by 5.35 points, p 0.05), Jitter (by 0.63 points, p < 0.05), Shimmer (by 2.34 points, p < 0.05) and Penetration aspiration score (by 1.8 points, p < 0.05) noted 2 h post procedure and this effect maintained till 6 month of follow up. There was significant increase in MPT (by 7.2 seconds, p < 0.05) and HN Ratio (by 6.22 points, p < 0.05) noted 2 h post procedure and this effect maintained till 6 month of follow up. All patients (100%) achieved statistical improvement in both voice and swallowing parameter after injection laryngoplasty and this improvement maintained till 6 months. Out of the total 40 cases, 6 (15%) cases of malignancies could not survive the study duration because of primary illness, 06 (15%) cases recovered spontaneously, 24 (60%) cases were not recovered but compensated by opposite vocal cord. A total of 04 (10%) cases required medialization thyroplasty in view of progressive deterioration of benefit. Average duration of benefit was 6 month and there was no major complication noted. Early percutaneous injection medialisation laryngoplasty is a safe and effective procedure in patients with UVCP with evidence of significant long-lasting improvement in voice and swallowing.