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

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

criteria (5/9; 56%), patient sampling (6/9; 67%), detection bias (7/9; 78%), and avoidance bias (4/9; 44%).= 92)

Patient-reported outcome measures (PROMs) such as a patient-reported scale and a determination of the presence of aspiration on an instrumental assessment (i.e., FEES or VFSS) were employed most frequently, each in 5 studies. Patients underwent some form of therapy with SLP for dysphagia in addition to the medialization procedure in 8/9 (89%) studies, but the timing and extent of therapy were unspecified in all cases. In 4 studies, a statistically significant improvement in swallowing function after the procedure was reported, [21, 26–28] although 3 studies demonstrated no statistically significant improvement [22–24]. The two remaining studies only reported descriptive statistics without statistical testing for swallowing outcomes [20, 25]. Authors concluded clinically significant improvement in swallowing function in 7/9 (78%) studies [20, 21, 23, 25–28], includ ing one study where the improvement was not statistically significant [23]. Risk of bias assessments is summarized in Table 4. All studies provided adequate rationale, stated clear objectives, and were free of commercial support. Most studies mini mized attrition (7/9; 78%) and reporting bias (7/9; 78%) and provided sufficient information for study replication (6/9; 67%). Areas of methodological weakness included selection Risk of Bias

Discussion This systematic review suggests that treatment of UVFP in adults with vocal fold medialization procedures of injec tion augmentation or medialization thyroplasty can improve swallowing outcomes. However, statistically significant improvement in swallowing outcome measures was not consistently identified. In part, this may be due to the het erogeneity of patient selection criteria, operative technique/ type of augmentation material, and method of swallowing assessment. Post-procedure swallowing assessment varied among PROMs, VFSS, FEES, or high-resolution manome try. The outcome measures varied even among studies using VFSS. For instance, in studies assessed via VFSS, binary presence or absence of aspiration, Penetration–Aspiration Scale (PAS) score, an alternative scoring system, or another type of descriptive analysis of swallowing pathology were all utilized [20, 22, 25]. A recent systematic review reported the effects of injec tion laryngoplasty on aspiration in patients with acute iatro genic vocal fold paralysis [29]. This review included a wide

Table 4 Risk of bias assessment

Reference

Study Type

Avoidance Bias

Reporting Bias

Government/

Rationale ̵̵ ̵̵ ̵̵ ̵̵ ̵ ̵̵ ̵̵ ̵̵ ̵ Clear Objective(s) Selection Criteria Replication Sampling Detection Bias Attrition Bias

Institutional/

Commercial Support

Abdel-Aziz 1998 x

Cohort

Atallah 2019 x

Case Series

Bhattacharyya 2002 x Case Series

Dworkin 2006 x Kammer 2019 x

Cohort

Case Series Case Series Case Series Case Series Case Series

Laccourreye 1999 x

Ohmae 1995 x Pinna 2019 x Wang 2012 x

Key: = low risk of bias; = unknown risk of bias; = high risk of bias. - absent, ✓ present

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