title: Medialization versus reinnervation for unilateral vocal fold paralysis: a multicenter randomized clinical trial.
abstract: OBJECTIVE
  Vocal fold medialization laryngoplasty (ML) and laryngeal reinnervation (LR) as treatments for unilateral vocal fold paralysis (UVFP) were compared in a multicenter, prospective, randomized clinical trial.
  
  
  METHODS
  Previously untreated patients with UVFP were randomized to undergo either ML or LR. Voice results were compared pretreatment and at 6 and 12 months posttreatment using perceptual ratings by untrained listeners (RUL), blinded speech pathologist GRBAS scores, and voice-related quality of life (VRQOL) scores. Other secondary data included maximum phonation time (MPT), cepstral analysis, and electromyography (EMG) findings.
  
  
  RESULTS
  Twenty-four patients from nine sites completed the study, 12 in each group. There were no significant intergroup differences in pretreatment variables. At 12 months, both study groups showed significant improvement in RUL, total GRBAS (grade, roughness, breathiness, asthenia, and strain) scores, and VRQOL scores, but no significant differences were found between the two groups. However, patient age significantly affected the LR, but not the ML, group results. The age less than 52 LR subgroup had significantly (P < .05) better scores than the age more than 52 LR subgroup, and had better RUL and GRBAS scores than the age less than 52 ML subgroup. The age more than 52 ML subgroup results were significantly better than the age more than 52 LR subgroup. The secondary data generally followed the primary data, except that the MPTs for the ML patients were significantly longer than for the LR patients.
  
  
  CONCLUSIONS
  ML and LR are both effective surgical options for patients with UVFP. Laryngeal reinnervation should be considered in younger patients, whereas medialization laryngoplasty should be favored in older patients.
authors: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA. paniellor@ent.wustl.edu
authors: Randal C
authors: RC
authors: Paniello
authors: Julia D
authors: JD
authors: Edgar
authors: Dorina
authors: D
authors: Kallogjeri
authors: Jay F
authors: JF
authors: Piccirillo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058753:Laryngoplasty / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D020127:Recovery of Function; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013070:Speech Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000601:surgery*; D014833:Voice Quality