title: Is testing the voice under sedation reliable in medialization thyroplasty?
abstract: OBJECTIVE
  Medialization thyroplasty is an accepted method for improving non-compensated unilateral vocal cord palsy. Most surgeons decide the depth of penetration of the prosthesis by monitoring the voice changes in the patient during the surgical procedure. General anesthesia with intubation is incompatible with this procedure. Sedation is recommended. In this study we want to objectivize and quantify the influence of sedation and position on voice in order to know if this anesthetic procedure is justified in medialization thyroplasties.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  This study involved 15 adult patients who underwent sedation. Voice recordings were performed in each patient in three different positions and conditions: the seated position without sedation, the supine position without sedation, and the supine position under the effects of sedation. The sedation drugs used were midazolam, fentanyl, and propofol. The level of sedation was monitored using the observational scale and the bispectral index.
  
  
  RESULTS
  The acoustic data obtained from sustained vowel sounds from patient recordings showed that sedation significantly affected the values of pitch. Compared to recordings from patients without sedation, pitch values in patients under sedation were significantly higher for jitter local and shimmer local recordings and significantly lower for pitch and harmonics-to-noise ratio. The supine position was shown not to influence on the voice.
  
  
  CONCLUSIONS
  Sedation exerts an important influence on voice quality. General anesthesia could be an alternative, focusing our attention on monitoring the glottis with a fibrolaryngoscope during the surgical procedure. No sedation at all can also be an alternative.
authors.affiliation: a ENT Department , Valencia , Spain.
authors.forename: Natsuki
authors.initials: N
authors.lastname: Oishi
authors.affiliation: a ENT Department , Valencia , Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Herrero
authors.affiliation: b Department of Anesthesiology , University General Hospital , Valencia , Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Martin
authors.affiliation: a ENT Department , Valencia , Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Basterra
authors.affiliation: a ENT Department , Valencia , Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Zapater
mesh_terms: D000162:Acoustics; D000328:Adult; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D058753:Laryngoplasty / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D056888:Patient Positioning; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D013061:Speech Acoustics; D013068:Speech Production Measurement; D016683:Supine Position; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014827:Vocal Cords / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality / Q000187:drug effects*
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol
keywords: Acoustic analysis; medialization thyroplasty; position; sedation