title: Prospective multi-arm evaluation of surgical treatments for vocal fold scar and pathologic sulcus vocalis.
abstract: OBJECTIVE
  The purpose of this study was to compare the clinical effectiveness of type I thyroplasty, injection laryngoplasty, and graft implantation for the treatment of vocal fold scar and pathologic sulcus vocalis.
  
  
  METHODS
  Prospective, multi-arm, quasi-experimental research design.
  
  
  METHODS
  Twenty-eight patients with newly diagnosed vocal fold scar and/or pathologic sulcus vocalis were assigned to one of three treatment modalities: type I thyroplasty (n = 9), injection laryngoplasty (n = 9), and graft implantation (n = 10). Psychosocial, auditory-perceptual, acoustic, aerodynamic, and videostroboscopic data were collected pretreatment and at 1, 6, 12, and 18 months posttreatment.
  
  
  RESULTS
  Type I thyroplasty and graft implantation both resulted in reduced voice handicap with no concomitant improvement in auditory-perceptual, acoustic, aerodynamic, or vocal fold physiologic performance. Injection laryngoplasty resulted in no improvement on any vocal function index. Patients who underwent graft implantation exhibited the slowest improvement trajectory across the 18-month follow-up period.
  
  
  CONCLUSIONS
  A persistent challenge in this area is that no single treatment modality is successful for the majority of patients, and there is no evidence-based decision algorithm for matching a given treatment to a given patient. Progress therefore requires the identification and categorization of predictive clinical features that can drive evidence-based treatment assignment.
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin, USA. welham@surgery.wisc.edu
authors.forename: Nathan V
authors.initials: NV
authors.lastname: Welham
authors.forename: Seong Hee
authors.initials: SH
authors.lastname: Choi
authors.forename: Seth H
authors.initials: SH
authors.lastname: Dailey
authors.forename: Charles N
authors.initials: CN
authors.lastname: Ford
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Jiang
authors.forename: Diane M
authors.initials: DM
authors.lastname: Bless
mesh_terms: D000368:Aged; D002921:Cicatrix / Q000473:pathology / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D006801:Humans; D058753:Laryngoplasty; D008297:Male; D008875:Middle Aged; D010699:Phonation; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011446:Prospective Studies; D019736:Prostheses and Implants; D013061:Speech Acoustics; D013957:Thyroid Cartilage / Q000601:surgery; D014827:Vocal Cords / Q000473:pathology / Q000601:surgery*; D014832:Voice Disorders / Q000601:surgery*; D014833:Voice Quality
chemical_list: D011138:Polytetrafluoroethylene