[Surgery for unilateral recurrent nerve paralysis]

Abstract

Introduction: Medialisation surgery for unilateral recurrent nerve paralysis has been performed for the past 100 years to improve voice quality. The aim of this paper is to describe our surgical methods and evaluate the results using subjective and objective parameters with an emphasis on acoustic voice analysis.

Material and methods: Retrospective cohort study of 42 consecutively operated patients from 1996 to 2006. Twenty-eight patients were treated with a hydroxyapatite prosthesis, which was inserted into the larynx (VoCom), nine patients had a silicone bead oil injected into the paretic vocal fold, and the remaining five received a combination of the mentioned procedures. The subjective evaluation was based on the patient's description of voice quality, while objective quality of the voice was assessed by acoustic voice analysis performed with the Multi-Dimensional Voice Program (MDVP) and visual evaluation was performed with videostroboscopy.

Results: The voice quality for both surgical methods was improved according to subjective as well as objective parameters. Forty-one out the 42 patients were satisfied with their voice. The MDVP analysis shows an improvement of the mean values for jitter (3.74 to 1.45), shimmer (9.9 to 4.62) and soft phonation index (23.22 to 15.61). MDVP and videostroboscopy show that the improvement is more easily achieved in patients with large deficits in glottic closure.

Conclusion: Surgical treatment of permanent unilateral recurrent nerve paralysis is an effective and safe procedure which should be offered to all relevant patients with voice problems.