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

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Coulter et al 2 16

3 Otolaryngology–Head and Neck Surgery Otolaryngology–Head and Neck Surgery, Vol. 168(1)

Figure1. Flow diagram of the literature search based on the PRISMA recommendations (Preferred Reporting Items for Systematic Reviews and Meta-analyses). VFI, vocal fold immobility.

prolonged monitoring, incision-related complications), while major complications were those judged to be permanent or requiring major intervention (ie, postoperative intubation/tra cheostomy, revision surgical procedure, or readmission). Assessing Methodological Quality The quality of each study was assessed per the MINORS cri teria (Methodological Index for Nonrandomized Studies). 30 Eight items are scored for noncomparative studies and 12 items for comparative studies, each 0 to 2 points for possible totals of 16 and 24, respectively. The ideal score is 16 for non comparative studies and 24 for comparative studies. For the purposes of this review, \ 11 was considered a high bias risk and 11 a low risk of bias, similar to other reviews. Analysis of Study Data Qualitative and quantitative analyses were performed. Although the individual studies had wide variation in out comes, most cited either subjective or objective measures of success as well as complications. A quantitative analysis of complications of vocal fold medialization procedures to

address UVFI was undertaken by utilizing all studies that reported them. In an effort to overcome the heterogeneity of outcome measures in these studies, the second quantitative analysis focused on a dichotomous representation of overall treatment success of vocal fold medialization procedures for UVFI restricted to subjects with individually extractable data, whereby outcomes for dysphagia and/or aspiration were docu mented by any outcome measure. Just the data for those sub jects who had dysphagia and/or aspiration prior to the procedure were extracted. This often necessitated extraction of individual subject data from larger cohorts. While dichoto mizing the outcome measure to success or failure reduces the specificity of the analysis and limits the scope of recom mendations that can be generated by the analysis, this metho dology is essentially the only way to analyze such a heterogeneous data set in a systematic way. Additionally, sub jects were included if recovery of vocal fold mobility was not expected (based on time from injury or mechanism of injury) or if lack of recovery was verified at the postprocedure eva luation (for acute interventions). If recovery of motion was documented in a patient after the procedure, that patient who