Part 1: Assessing Treatment Effectiveness and Recovery in Patients With Unilateral Vocal Fold Paresis/Paralysis Using Measures of Acoustic Glottal Stop Production

Document Type

Journal Article

Publication Date

6-5-2025

Journal

Journal of voice : official journal of the Voice Foundation

DOI

10.1016/j.jvoice.2025.05.008

Abstract

OBJECTIVES/HYPOTHESIS: A group of patients with unilateral vocal fold paresis/paralysis (UVFP) were studied following surgery after a year's observation to assess treatment effectiveness. A second group was studied following no intervention for up to 12 months to assess spontaneous recovery. Novel acoustic measures of glottal stop production (GSP) were used to assess changes in laryngeal function. It was hypothesized that these measures would reflect change following treatment as effectively as more traditional measures. Following observation or injection, a return of the acoustic GSP measures to within normal limits (WNL) would be related to patient-reported voice normalization (ie, return to premorbid quality), a standard measure of recovery. STUDY DESIGN: The design was retrospective, analytical, observational, case-control study. METHODS: Forty-four patients diagnosed by a certified otolaryngologist with UVFP participated (13 observed, 7 injected, and 24 following surgeries), with iatrogenic (22), idiopathic (18), and viral (4) etiologies. Acoustic measures based on GSP (ie, onset and offset intensity differences and slopes) and number of voicing cessations were studied, as well as traditional outcome measures, including maximum phonation time (MPT), airflow, s/z ratio, jitter, and shimmer. Agreement using Cohen's kappa coefficients between patient-reported voice normalization and the return to WNL for both measure types following observation or injection was also studied. RESULTS: Improvements were demonstrated for both measure types following treatment. Traditional outcome measures demonstrated larger effect sizes. Significant increases in the number of voicing cessations within individuals were found postobservation. Fair/moderate Cohen's kappa coefficients for those observed and injected were reported between patient-reported normalized voice and return to WNL of airflow (0.45) and onset slope values (0.3) and at least one voicing cessation present (0.35). CONCLUSIONS: Acoustic GSP measures were able to reflect treatment effectiveness, and with further study, may be useful for monitoring peripheral nerve recovery over time.

Department

Surgery

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