xRead - Swallowing Disorders in the Adult Patient (October 2024)

1773

S. I. Dhar et al.: Does Medialization Improve Swallowing Function in Patients

Table 1 Summary of all included prospective studies on dysphagia outcomes after vocal fold medialization in adults with unilateral vocal fold paralysis

Study

Country Prospective Study type Funding

Study N Sex (M/F)

Age: Mean (SD) or Median (IQR)

Injection medialization/ Medialization Implant

Abdel-Aziz, 1998 England Cohort

None None None None None None None

12 (5/7)

56 (63, 52)

Implant Implant

Atallah, 2019

France Case series

22 23 20

Bhattacharyya, 2002 U.S.

Case series

62 (13)

Injection ( n =17), Implant ( n =6) Injection ( n =10), Implant ( n =10)

Dworkin, 2006 Kammer, 2019 Ohmae, 1995 Pinna, 2019 Wang, 2012

U.S. U.S.

Cohort

Case series

Institutional 17 (11/6)

69 (54, 73) 59 (SD=NR) 72 (55, 76) 50 (IQR=NR)

Injection Injection Injection Implant Injection

Laccourreye, 1999 France Case series

20 (13/7)

Japan Case series

8 (6/2)

Brazil

Case series

15 (5/10)

Taiwan Case series

Institutional 20 (6/14)

52 (44, 62)

Totals

2/10

N = 157 7/9

Injection (n=92), Implant ( n =65)

IQR interquartile range, U.S. United States, SD standard deviation

Table 2 Characteristics of included patients’ unilateral vocal fold paralysis and its treatment types (N=157)

Table 3 Dysphagia evaluations and outcomes in adult patients with unilateral vocal fold paralysis treated with vocal fold medialization.

N (%) a

Characteristics

Methods

Number of studies a

Etiology of paralysis Intubation

Swallowing function PRE-procedure Patient-reported scale Clinician-reported/symptom assessment Videofluoroscopic Swallow Study

3 (2)

2 2 3 3 3 3 5 3 2

Idiopathic

14 (9)

Neurological

2 (1)

Surgical Trauma

74 (47)

Endoscopy Manometry

5 (3)

Tumor

15 (10) 43 (27)

Other

Unspecified/Not clear Other (aortic aneurysm) Identification of paralysis Laryngoscopy WITH strobe Laryngoscopy WITHOUT strobe

Swallowing function POST-procedure Patient-reported scale Videofluoroscopic Swallow Study

1 (1)

62 (39) 55 (35) 40 (25) 20 (22) 10 (11) 20 (22) 14 (15) 3 (3)

Endoscopy Manometry

3 Determination of changes in swallowing function POST-procedure Physiologic measurements 3 Swallowing event parameters 1 Determination of aspiration 5 Patient Reported Outcome Measures (PROMs) 5 Pharyngeal clearance of contrast 1

Other

Injection augmentation material (N= 92) Restylane

Cymetra

Teflon

Fat

Gel foam Silicone

8 (9)

a Studies may have used more than one method

Other* (Juvederm, Radiesse “most frequently”) Medialization implant approach and material (N = 65) Transcervical–silastic

17 (18)

27(42) 22 (33) 16(25)

Swallowing Outcomes

Transoral - silastic

Transcervical – material unspecified

Timing of swallowing reassessment after the procedure var ied from “immediately” to 12 months post procedure. Four of the studies re-evaluated swallowing at multiple different intervals separated by month(s) within the first year after the procedure. A variety of methods were used to identify and determine changes in swallowing after the procedure and some studies used more than one method (Table 3).

a Studies may have used more than one method

2). The remaining patients underwent medialization thy roplasty, most commonly with an transcervical-silastic (27/65; 42%) followed by transoral-silastic (22/65, 33%) (Table 1, 2).

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