title: Voice Outcomes Following Posterior Cordotomy With Medial Arytenoidectomy in Patients With Bilateral Vocal Fold Immobility.
abstract: OBJECTIVE
  Voice quality-of-life (VQOL) and perceptual voice outcomes are presumed to worsen following posterior cordotomy with medial arytenoidectomy for bilateral vocal fold immobility (BVFI); however, subjective and objective voice outcomes are not well studied in this postsurgical patient population.
  
  
  OBJECTIVE
  To evaluate VQOL and perceptual voice outcomes following posterior cordotomy with medial arytenoidectomy for BVFI.
  
  
  METHODS
  Retrospective medical record review of 15 patients with BVFI who underwent posterior cordotomy with medial arytenoidectomy at a tertiary care academic hospital from 2009 to 2012.
  
  
  METHODS
  Suspension microlaryngoscopy was performed to expose the posterior glottis. A posterior cordotomy and medial arytenoidectomy was performed anterior to the vocal process of the vocal fold in a medial to lateral fashion.
  
  
  METHODS
  Data included age, sex, tracheostomy status, number of cordotomies, and voice outcomes. Voice-Related Quality of Life (VRQOL) and Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) data were collected preoperatively and postoperatively surrounding a single procedure. Comparisons within a single group were performed with a paired t test. Statistical significance was determined at P ≤ .05.
  
  
  RESULTS
  Eight patients (53%) were male, and 7 (47%) were female. Six patients (40%) required a tracheotomy at some point during treatment, 4 were successfully decannulated. For all 15 patients, the mean VRQOL scores improved 12 points from 47.33 to 59.33 after posterior cordotomy (P = .12). Mean CAPE-V overall severity scores in 13 patients increased 26 points after posterior cordotomy with medial arytenoidectomy from 38.12 to 62.77 (P = .01), indicating further deviance from normal.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to compare VQOL with perceptual voice outcomes following posterior cordotomy with medial arytenoidectomy in a series of patients with BVFI. Patients who underwent posterior cordotomy in this study had significantly reduced perceptual voice outcomes with unchanged VQOL. While postcordotomy patients have a dysphonia that is noticeable to voice professionals, most patients in this study subjectively felt as though their voice improved after surgery. Surgeons should be aware of these factors when counseling patients considering cordotomy for BVFI.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hillel
authors.affiliation: Emory Voice Center, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Laureano
authors.initials: L
authors.lastname: Giraldez
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Idris
authors.initials: I
authors.lastname: Samad
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gross
authors.affiliation: Emory Voice Center, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Klein
authors.affiliation: Emory Voice Center, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Johns
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001193:Arytenoid Cartilage / Q000601:surgery*; D005260:Female; D006801:Humans; D058753:Laryngoplasty / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D014140:Tracheotomy; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality