Long-term results of different treatment modalities for glottic insufficiency

Purpose: The purpose of this study was to investigate the early and long-term functional results of thyroplasty type-I and injection laryngoplasty using fat or calcium hydroxylapatite. Materials and methods: Thirty patients with glottic insufficiency were included and followed up between 1-7 years. Patients with glottic bowing or sulcus vocalis were selected for injection augmentation of the vocal folds, while those with unilateral vocal fold immobility underwent medialization thyroplasty. Perceptual and acoustic analysis of voice, and videolaryngostroboscopy were performed before and after surgery. Results: After the surgery, GRBAS scale of all patients demonstrated significant change in grade of severity, roughness, and breathiness. Acoustic analysis demonstrated significant change in Fo, jitter, shimmer, noise to harmonic ratio, and maximum phonation time (MPT) in thyroplasty group, while those demonstrated significant change in Fo (lowest) and jitter, and MPT in injection augmentation group. Conclusions: Medialization thyroplasty is the gold standard for the management of glottic insufficiency, regardless of the severity of glottic gap. However, injection augmentation of the vocal folds may be considered as an alternative in the treatment of patients with small glottic gap. Further studies with larger groups and long follow-up periods are required to figure out the proper material for injection laryngoplasty. (C) 2008 Elsevier Inc. All rights reserved.