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

Conclusion We conclude there is moderate evidence to support the use of vocal fold medialization to improve swallowing function in patients with UVFP. However, the heterogeneity of study populations, variations in intervention technique, variations in outcome measures, and other confounding variables limit our ability to determine the clinical impact and strength of vocal fold medialization as an intervention. Further prospec tive clinical studies with control groups and validated out come measures (e.g., Eating Assessment Tool, SWAL-QOL, penetration–aspiration scale, pharyngeal contractile integral [30–33]) will be necessary to better isolate the effect of vocal fold medialization on swallowing function in UVFP patients. Supplementary Information The online version contains supplemen tary material available at https://d​ oi.o​ rg/1​ 0.1​ 007/s​00455-0​ 22-1​ 0441-5. Author Contributions SID: co-first author writer, title and abstract reviewer, full-text reviewer; MAR: co-first author, writer, title and abstract reviewer, full-text reviewer; ACD: title and abstract reviewer; EJ: title and abstract reviewer; KP: title and abstract reviewer; CP: manuscript editing, medical librarian; MBB: co-senior author, manu script editing, study design; LMA: co-senior author, manuscript edit ing, study design References 1. Misono S, Merati AL. Evidence-based practice: evaluation and management of unilateral vocal fold paralysis. Otolaryngol Clin North Am. 2012;45:1083–108. 2. Cates DJ, Kuhn MA. Management of dysphagia in unilateral vocal fold paralysis. In: Amin MR, Johns MM, editors. Decision mak ing in vocal fold paralysis: a guide to clinical management [Inter net]. Cham: Springer International Publishing; 2019 [cited 2021 Mar 6]. pp. 41–55. https://d​ oi.o​ rg/1​ 0.1​ 007/9​ 78-3-0​ 30-2​ 3475-1_4. 3. Husain S, Sadoughi B, Mor N, Sulica L. Time Course of Recovery of Iatrogenic Vocal Fold Paralysis. Laryngoscope. 2019;129:1159–63. 4. Husain S, Sadoughi B, Mor N, Levin AM, Sulica L. Time course of recovery of idiopathic vocal fold paralysis. Laryngoscope. 2018;128:148–52. 5. Sridharan SS, Rosen CA. Diagnostic studies in workup for vocal fold paralysis: when and why. In: Amin MR, Johns MM, edi tors. Decision making in vocal fold paralysis: a guide to clini cal management. Cham: Springer International Publishing; 2019 [cited 2021 Mar 6]. pp. 3–12. https://​doi.​org/​10.​1007/​ 978-3-​030-​23475-1_1. 6. Tam S, Sun H, Sarma S, Siu J, Fung K, Sowerby L. Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis. J Otolaryngol Head Neck Surg. 2017;46:14. Declarations Conflict of interest Martin B Brodsky PhD ScM discloses a relation ship with MedBridge, Inc. No other conflicts of interest to disclose by other authors.

range of study designs, including lower quality retrospec tive cohort and case studies. Outcomes measures included “clinical assessment,” FEES or VFSS interpretation, PAS, or advancement of diet. Of the 14 studies they included, only 3 overlapped with studies included in our review [22, 24, 25]. The authors concluded that evidence to support injec tion laryngoplasty in treating aspiration in patient with acute iatrogenic UVFP was inconclusive and called for prospective studies with quantitative measures being needed [29]. This differed from our review’s objectives and method ology in several categories. Our patient population had a wider scope and included patients with dysphagia and all cause UVFP including not only iatrogenic, but also idio pathic, neurological, traumatic, and others. In our review, interventions were not limited to injection augmentation, and included other types of medialization procedures (e.g., thyroplasty). In addition, swallowing function—not solely the presence of aspiration—was assessed both pre- and post intervention as a criterion for study inclusion. Despite the rigorous methodology employed in an effort to clarify impact of medialization on swallowing function in patients with UVFP, we still encountered several limita tions in the present study. There was substantial missing data from the studies reviewed, especially for patient demograph ics, how vocal fold paralysis was verified, material used for injection, timing of the pre-procedure swallowing assess ment, timing of the procedure after the diagnosis of UVFP, and details about therapy with SLP. For some of the studies, dysphagia was the secondary outcome and voice was pri mary outcome. Therefore, not all patients included necessar ily had dysphagia despite their UVFP, possibly limiting the potential study outcomes. For instance, one study reported 8 of 12 patients had pre-procedure aspiration, whereas another study included all patients with a PAS >3, suggesting greater compromise to airway protection [20, 24]. We also limited studies to only those with prospective study designs, perhaps influencing prevalence estimates. With regard to our selection criteria, by excluding patients with CNS disorders, neoplasms of the head and neck, and connective tissue disorders, this study is limited in its generalizability—by design, the results presented here are applicable only to patients with isolated TVCP as it relates to their dysphagia. The authors recognize this limita tion and feel that it is a reasonable trade-off in order to limit the confounding effect that non-TVCP etiologies of dyspha gia may have had on ability to discern impact of vocal fold medialization. Lastly, despite our strict criteria, it was challenging to identify cases with comorbid conditions that could be con founding such as esophageal cancer, other cranial neuropa thies, radiation to the head and neck as this was not always reported.

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