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Wilma Harnisch, Dr med; Sibylle Brosch, Prof Dr med; Michael Schmidt, Prof Dr med; Rudolf Hagen, Prof Dr med

Arch Otolaryngol Head Neck Surg. 2008;134(3):278-284.

Objective  To evaluate long-term results of surgical treatment for bilateral vocal cord paralysis using objective and subjective measures of breathing and voice quality.

Design  Prospective cross-sectional case series.

Setting  Tertiary care otolaryngology and speech pathology referral center.

Patients  Ten patients with bilateral vocal cord paralysis who underwent surgical treatment between October 1996 and May 2006 at the Department of Otorhinolaryngology–Head and Neck Surgery, University of Würzburg, were examined at a mean of 27.2 months after surgery.

Main Outcome Measures  Glottal area, voice range profile, Voice Handicap Index, pulmonary function test results, Göttingen Hoarseness Diagram, microlaryngostroboscopic findings, chronic respiratory disease questionnaire, and European Organization for Research and the Treatment of Cancer quality-of-life questionnaire, including the head and neck module.

Results  Residual recurrent nerve function was seen in 9 of 10 patients. Pulmonary data varied widely and did not correlate with the size of the glottal area. Quality of life, subjective dyspnea, and physical functioning correlated with expiratory airflow measures. Voice range was reduced in all patients. High breathiness and reduced maximum phonation time led to increased Voice Handicap Index scores.

Conclusions  Microlaryngostroboscopic findings did not necessarily correlate with subjective dyspnea and vocal complaints. Reduction of inspiratory speaking efforts and acquisition of special breathing techniques improve airflow stability and effectiveness of respiration, leading to enhanced quality of life.

Author Affiliations: Departments of Otorhinolaryngology–Head and Neck Surgery (Drs Harnisch, Brosch, and Hagen) and Medicine (Dr Schmidt), University of Würzburg, Würzburg, Germany. Dr Brosch is now with the Section of Phoniatrics and Pedaudiology, University Hospital for Diseases of the Ear, Nose, and Throat (ENT) Ulm, Ulm, Germany.

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