gms | German Medical Science

Introduction: The bilateral vocal cord palsy is a potentially reversible disease in the first 6 months, because in many cases the movement of the vocal cord can recover spontaneously. Nowadays instead of tracheotomy a new concept has become popular in the acute treatment of severe dyspnoea in the early phase of the palsy: the lateralisation of the vocal chord with a “simple” suture technique. Authors report a procedure where a properly wide glottis was achieved by the abduction of the arytenoid cartilage through an endo-extralaryngeal suture technique by “Lichtenberger” needle carrier. The goal of this paper is to examine – with the help of objective measurement – whether the applied method causes significant damage in the larynx from the phoniatric aspect.

Materials and Methods: Between January 1998 and January 2003 the urgent laterofixatoin due to bilateral vocal chord palsy was performed in 42 patients. In 6 women and 1 man after the intervention the movements recovered in both sides. The Hungarian “í” sound (in English e:) was examined in these 7 patients at different dates with a phoniatric computer program. The examined dates were: before the operation (A), within 1 week after the glottis widening operation (B), after the detection of the recovery of the movements of the vocal cords before the removal of the laterofixation suture (C), within a week after the removal of the suture (D), in the 6th months after the suture removal. (E).The examined parameters were: maximal phonation time (MPT), signal-noise ratio/harmonicity (HNR), jitter (Jitt), shimmer dB (Sh dB) base frequency/pitch (Fo). The phoniatric results were compared with the stroboscopic examinations of the coherent times.

Results: average values: MPT (s): 1,7 (A), 2,2 (B), 4,8 (C), 10,5 (D), 18,7 (E); HNR (dB): 18,8 (A), 13,2 (B), 19,5 (C), 22,2 (D), 27,4 (E); Jitt (%): 18,8 (A), 2,37 (B), 0,56 (C), 0,45 (D), 0,23 (E); Sh dB (dB): 0,35 (A), 0,64 (B), 0,43 (C), 0,25 (D), 0,14 (E) ; Fo (Hz): 240 (A), 197 (B), 228 (C), 213 (D), 246 (E).

Discussion: The investigated parameters verified a continuous and obvious improvement of the sound quality. In the last examined date (E) normal physiological parameters were measured which were in good accordance with the results of the stroboscopic examinations. The results confirms the clinical observation that minimal invasive glottis widening operation based on the physiological abduction of the arytenoid cartilage which is performed in the “early” phase of the vocal chord palsy is reversible from the phonation’s point of view.