Comparison of voice and swallowing parameters after endoscopic total and partial arytenoidectomy for bilateral abductor vocal fold paralysis: a randomized trial

IMPORTANCE: Total arytenoidectomy is claimed to increase risk of aspiration and cause more voice loss than other operations performed for bilateral abductor vocal fold paralysis (BVFP). However, objective evidence for such a conclusion is lacking. There is no study comparing swallowing and voice after total and partial arytenoidectomy.

OBJECTIVE: To compare voice and swallowing parameters after endoscopic total and partial arytenoidectomy for BVFP.

DESIGN, SETTING, AND PARTICIPANTS: In this prospective, randomized, double-blind, case-control study conducted at a tertiary referral university, the study population comprised 20 patients with BVFP.

INTERVENTIONS: Endoscopic total and partial arytenoidectomy.

MAIN OUTCOMES AND MEASURES: Decannulation, duration of operation, Voice Handicap Index, acoustic and aerodynamic analysis, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale.

RESULTS: Median duration of partial and total arytenoidectomies were 59 and 49 minutes, respectively. This difference was statistically significant (P = .04). Comparisons of preoperative and postoperative Voice Handicap Index, acoustic and aerodynamic measures, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale were not statistically significantly different between both groups.

CONCLUSIONS AND RELEVANCE: Endoscopic total and partial arytenoidectomy are very successful static surgical options for BVFP. Partial takes longer than total arytenoidectomy. They both provide a comfortable airway, acceptable voice, and acceptable deglutition. It may be a sound practice to perform partial arytenoidectomy initially for primary BVFP cases and reserve total arytenoidectomy for revision cases.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01824849.