Vocal Fold Medialization Procedures for 30 Cases of Glottic Insufficiency: Our Experience

Introduction: Glottic insufficiency which is inability to obtain complete vocal fold approximation during phonation is a common cause for dysphonia. Vocal fold immobility, vocal fold sulcus, presbylaryngis, vocal fold scarring are common causes. Materials and methods: We have studied 30 cases of glottic insufficiency that failed conservative management and underwent surgical intervention. Voice parameters like maximal phonation time (MPT) and voice handicap index (VHI) have been used as assessment parameters along with laryngoscopic examination. Observations and results: Twenty-one cases had vocal fold immobility, while the rest had vocal sulcus (7), vocal fold atrophy (1), vocal fold scarring (1) as the cause. All cases presented with voice change with few having symptoms of aspiration. Patients were subjected to either vocal fold injection or medialization thyroplasty depending on the etiology and severity, and the outcomes assessed. Majority of our cases showed good amount of improvement on videolaryngoscopy and voice analysis (MPT, VHI scores). Mean MPT scores improved from 7.57 seconds (pre-operative) to 18.83 seconds (final post-operative) and VHI scores changed from a mean of 49.6 to 26.57. Few had post operative problems like vocal fold oedema, under correction, implant malposition. Four patients needed revision procedures due to suboptimal results. Conclusion: Selection of the most suitable procedure for each patient, meticulous and precise technique and adequate follow up will promise best results and minimize complications and undesired results in patients of glottic insufficiency.