Optimal arytenoid adduction based on quantitative real-time voice analysis.

Abstract

The optimal degree of arytenoid rotation for arytenoid adduction (AA) can be determined using quantitative real-time voice analysis. Repeated measures with each larynx serving as its own control. Unilateral vocal fold paralysis (VFP) was modeled in five excised canine larynges. Medialization laryngoplasty (ML) was performed, followed by AA. The optimal degree of arytenoid rotation was determined using real-time measurements of vocal efficiency (V(E) ), percent jitter, and percent shimmer. After the optimal degree of rotation was determined, the arytenoid was hypo- and hyperrotated 10% ± 2% of the optimal angle to mimic hypoadducted and hyperadducted states. Aerodynamic, acoustic, and mucosal wave measurements were recorded. Mean optimal angle of arytenoid adduction was 151.4 ± 2.5°. V(E) differed significantly across experimental conditions (P = .003). Optimal AA produced the highest V(E) of any treatment, but this value did not reach that produced in the normal condition. Percent jitter (P < .001) and percent shimmer (P < .001) differed across groups and were lowest for optimal AA. Mucosal wave amplitude of the normal (P = .001) and paralyzed fold (P = .043) differed across treatments. Amplitude of both folds was highest for optimal AA. V(E) and perturbation parameters were sensitive to the degree of arytenoid rotation. Using real-time voice analysis may aid surgeons in determining the optimal degree of arytenoid rotation when performing AA. Testing this method in patients and determining if optimal vocal outcomes are associated with optimal respiratory and swallowing outcomes will be essential to establishing clinical viability.