Effects of Implant Stiffness, Shape, and Medialization Depth on the Acoustic Outcomes of Medialization Laryngoplasty

Objective. Medialization laryngoplasty is commonly used to treat glottic insufficiency. In this study, we investigated the effects of implant stiffness (Young modulus), medialization depth, and implant medial surface shape on acoustic outcomes. Study Design. Basic science study using ex vivo laryngeal phonation model. Methods. In an ex vivo human larynx phonation model, bilateralmedialization laryngoplasties were performed with implants of varying stiffness, medial surface shape (rectangular, divergent, and convergent), and varying depths of medialization. The subglottal pressure, the flow rate, and the outside sound were measured as the implant parameters were varied. Results. Medialization through the use of implants generally improved the harmonic-to-noise ratio (HNR) and the number of harmonics excited in the outside sound spectra. The degree of acoustic improvement depended on the implant insertion depth, stiffness, and to a lesser degree implant shape. Varying implant insertion depth led to large variations in phonation for stiff implants, but had much smaller effects for soft implants. Conclusions. Implants with stiffness comparable to vocal folds provided more consistent improvement in acoustic outcomes across different implant conditions. Further investigations are required to better understand the underlying mechanisms.