Validity of intraoperative voice monitoring undergoing type 2 thyroplasty with titanium bridges for adductor spasmodic dysphonia

Tetsuji Sanuki; Nobuhiko Oridate; Ichiro Tateya; Takaharu Nito; Kenji Mizoguchi; Kenichiro Tanabe

doi:10.1002/lio2.898

Validity of intraoperative voice monitoring undergoing type 2 thyroplasty with titanium bridges for adductor spasmodic dysphonia

Laryngoscope Investig Otolaryngol. 2022 Aug 22;7(5):1481-1490. doi: 10.1002/lio2.898. eCollection 2022 Oct.

Authors

Tetsuji Sanuki¹, Nobuhiko Oridate², Ichiro Tateya³, Takaharu Nito⁴, Kenji Mizoguchi⁵, Kenichiro Tanabe⁶

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery Nagoya City University Graduate School of Medical Sciences Nagoya Aichi Japan.
² Department of Otolaryngology - Head and Neck Surgery Yokohama City University Yokohama Kanagawa Japan.
³ Department of Otolaryngology - Head and Neck Surgery School of Medicine, Fujita Health University Toyoake Aichi Japan.
⁴ Department of Otolaryngology Saitama Medical Center, Saitama Medical University Kawagoe Saitama Japan.
⁵ Department of Otorhinolaryngology National Hospital Organization Hokkaido Medical Center Sapporo Hokkaido Japan.
⁶ Pathophysiology and Bioregulation, St. Marianna University Graduate School of Medicine Kawasaki Kanagawa Japan.

Abstract

Objectives: The success of type 2 thyroplasty (TP2) for adductor spasmodic dysphonia (AdSD) depends on the selection of optimally sized titanium bridges, which requires accurate assessment of intraoperative vocal changes. While this procedure has traditionally been performed according to the laryngologist's experience, the most appropriate method for voice monitoring and selection of titanium bridge size remains to be determined. This study aimed to investigate evaluation parameters useful for voice monitoring, as these may allow less experienced surgeons to perform TP2 properly.

Methods: In this prospective study, voice monitoring was performed in 18 patients with AdSD patients undergoing TP2. Evaluations were performed preoperatively, intraoperatively, 13 weeks postoperatively, and 52 weeks postoperatively using GRBAS (grade, roughness, breathiness, asthenia, and strain), as well as perceptual judgment and acoustic analyses.

Results: Preoperative and intraoperative assessments of the G, R, B, and S parameters, perceptual judgment, and harmonic-to-noise ratio (HNR) were in moderate or better agreement. Intraoperative and 13- or 52-week postoperative measurements of the R, B, and G parameters and strangulation, tremor, and HNR were also in high agreement. When two different sizes of titanium bridges were compared (unselected vs. selected), ratings for G, R, S, strangulation, tremor, jitter, shimmer, HNR, standard deviation of F0, and degree of voice breaks were better for the selected width than the unselected width.

Conclusion: The candidate items for intraoperative voice monitoring during TP2 for AdSD are G, R, strangulation, tremor, and HNR. The use of these items may help to ensure successful TP2 and contribute to the advancement of laryngeal framework surgery.

Level of evidence: Level 4.

Keywords: GRBAS scale; acoustic analysis; perceptual judgment; type 2 thyroplasty; voice monitoring.