Better Outcome After Thyroplasty Type I in Unilateral Vocal Fold Paralysis Without Synkinesis and Synkinetically-Reinnervated Type IV Vocal Fold Paralysis
- 1Department of Otorhinolaryngology, Medical University of Vienna, Austria
Abstract
Importance: Thyroplasty type I is considered standard therapy in patients with chronic unilateral vocal fold paralysis (UVFP); revisions are frequently required. Objective: The aim of the study was whether synkinesis affects thyroplasty type I. Design: Retrospective data analysis. Participants: Patients with UVFP (age ≥18 years) after thyroplasty type I. Intervention of exposures: Between November 2019 and November 2022, 28 patients with chronic UVFP underwent thyroplasty type I and were followed up 6 months postoperatively. Prior to surgery, all patients underwent laryngeal electromyography (LEMG). Main outcome measures: Dysphonia Severity Index (DSI), perceptual voice sound analysis (GRBAS), voice acoustics (jitter %), maximum phonation time (MPT), voice range profile measurements (VRP), Voice Handicap Index (VHI-9), and laryngo(strobo)scopic findings were assessed preoperatively and up to 6 months after thyroplasty. For study purposes, the presence of synkinesis was retrospectively evaluated and classified according to the Crumley classification based on preoperative data. Statistical analyses were exploratory. A linear mixed-effects model was used to asses preoperative and postoperative DSI in patients with and without synkinesis. Statistical analyses were carried out with SPSS version 27. Results: Sixteen patients had a UVFP without and 12 with synkinesis. Among patients with synkinesis, 25% were classified as Crumley type II, 50% as type IV, and 25% as undefined. DSI improved significantly postoperatively across all patients ( P = .006). The greatest improvement in GRBAS score, MPT, and Jitter (%) were observed in UVFP patients with type IV and those without synkinesis. VHI-9 scores improved in patients with type IV synkinesis (n = 6) and those without synkinesis (n = 16). Complete glottal closure was achieved in most patients with (n = 7) and without synkinesis (n = 12). Conclusion: This study emphasizes the importance of preoperative LEMG in chronic UVFP before thyroplasty type I to identify unfavorable synkinesis types, as routine laryngo(strobe)scopy and voice acoustic evaluation do not allow any conclusion on aberrant reinnervation processes. Relevance: Patients with type IV are suitable candidates for thyroplasty type I. In type II and undefined synkinesis, thyroplasty type I alone is insufficient, and additional therapies should be considered.
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BibTeX
@article{kurz2026better,
title = {{Better Outcome After Thyroplasty Type I in Unilateral Vocal Fold Paralysis Without Synkinesis and Synkinetically-Reinnervated Type IV Vocal Fold Paralysis}},
author = {Annabella Kurz MD and Guan-Yuh Ho MD and Matthias Leonhard MD and Roland Paulus MD and Berit Schneider-Stickler MD},
journal = {Journal of Otolaryngology - Head and Neck Surgery},
year = {2026},
month = oct,
doi = {10.1177/19160216261487371},
url = {https://doi.org/10.1177/19160216261487371},
note = {CC BY},
}
RIS
TY - JOUR
TI - Better Outcome After Thyroplasty Type I in Unilateral Vocal Fold Paralysis Without Synkinesis and Synkinetically-Reinnervated Type IV Vocal Fold Paralysis
AU - Annabella Kurz MD
AU - Guan-Yuh Ho MD
AU - Matthias Leonhard MD
AU - Roland Paulus MD
AU - Berit Schneider-Stickler MD
PY - 2026
DA - 2026/10/24
JO - Journal of Otolaryngology - Head and Neck Surgery
DO - 10.1177/19160216261487371
UR - https://doi.org/10.1177/19160216261487371
AB - Importance: Thyroplasty type I is considered standard therapy in patients with chronic unilateral vocal fold paralysis (UVFP); revisions are frequently required. Objective: The aim of the study was whether synkinesis affects thyroplasty type I. Design: Retrospective data analysis. Participants: Patients with UVFP (age ≥18 years) after thyroplasty type I. Intervention of exposures: Between November 2019 and November 2022, 28 patients with chronic UVFP underwent thyroplasty type I and were followed up 6 months postoperatively. Prior to surgery, all patients underwent laryngeal electromyography (LEMG). Main outcome measures: Dysphonia Severity Index (DSI), perceptual voice sound analysis (GRBAS), voice acoustics (jitter %), maximum phonation time (MPT), voice range profile measurements (VRP), Voice Handicap Index (VHI-9), and laryngo(strobo)scopic findings were assessed preoperatively and up to 6 months after thyroplasty. For study purposes, the presence of synkinesis was retrospectively evaluated and classified according to the Crumley classification based on preoperative data. Statistical analyses were exploratory. A linear mixed-effects model was used to asses preoperative and postoperative DSI in patients with and without synkinesis. Statistical analyses were carried out with SPSS version 27. Results: Sixteen patients had a UVFP without and 12 with synkinesis. Among patients with synkinesis, 25% were classified as Crumley type II, 50% as type IV, and 25% as undefined. DSI improved significantly postoperatively across all patients ( P = .006). The greatest improvement in GRBAS score, MPT, and Jitter (%) were observed in UVFP patients with type IV and those without synkinesis. VHI-9 scores improved in patients with type IV synkinesis (n = 6) and those without synkinesis (n = 16). Complete glottal closure was achieved in most patients with (n = 7) and without synkinesis (n = 12). Conclusion: This study emphasizes the importance of preoperative LEMG in chronic UVFP before thyroplasty type I to identify unfavorable synkinesis types, as routine laryngo(strobe)scopy and voice acoustic evaluation do not allow any conclusion on aberrant reinnervation processes. Relevance: Patients with type IV are suitable candidates for thyroplasty type I. In type II and undefined synkinesis, thyroplasty type I alone is insufficient, and additional therapies should be considered.
SN - 1916-0216
ER -