title: The management of postintubation phonatory insufficiency.
abstract: BACKGROUND
  Prolonged intubation may lead to medial arytenoid cartilage erosion and cricoarytenoid joint scarring with subsequent glottic insufficiency. This has been referred to as postintubation phonatory insufficiency (PIPI). Reports on treatment outcomes for this condition are lacking.
  
  
  METHODS
  A single institution retrospective chart review from January 2007 to present was preformed for PIPI diagnosis. Data were collected for intubation, symptoms, diagnosis, interventions, and outcomes.
  
  
  RESULTS
  Five patients with PIPI underwent treatment to improve voice. Patient 1 underwent thyroplasty with adduction arytenopexy. Patient 2 had a revision thyroplasty and subsequently two injections of the posterior defect and true vocal fold. Patient 3 underwent injection of the medial arytenoid defect. Patient 4 had injection augmentation of the anatomic deficiency and the ipsilateral true vocal fold. Patient 5 underwent thyroplasty with adduction arytenopexy. Limited to no phonatory improvement was achieved in any case.
  
  
  CONCLUSIONS
  The management of patients with PIPI is difficult. Currently, no reliable means are available to restore cartilaginous defects in the respiratory glottis. Patients with this condition should be counseled as to the difficult nature of treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Emory Voice Center, Emory University, Atlanta, Georgia 30308, USA.
authors.forename: Lindsey C
authors.initials: LC
authors.lastname: Arviso
authors.forename: Adam M
authors.initials: AM
authors.lastname: Klein
authors.forename: Michael M
authors.initials: MM
authors.lastname: Johns
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010699:Phonation; D012189:Retrospective Studies; D014832:Voice Disorders / Q000209:etiology / Q000628:therapy*; D055815:Young Adult