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Clinical Challenges in Otolaryngology |

Commentary

Gayle D. Woodson, MD
Arch Otolaryngol Head Neck Surg. 2010;136(8):829. doi:10.1001/archoto.2010.113.
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The correct answer is probably, “It depends . . . ” Injection laryngoplasty is probably just as good as thyroplasty in some patients, in the hands of some surgeons. Indeed, for patients with mild dysphonia due to incomplete glottal closure, thyroplasty is probably “overkill,” like using a steamroller when a fly swatter would suffice. However, we do not yet have sufficient evidence to conclusively evaluate the outcomes. There are certainly no gold standard prospective controlled clinical trials. This is a common problem in evaluating surgical procedures, particularly those intended to improve function rather than to excise disease or repair an injury. There are many variables involved, including degrees of disability and causes of impaired glottic closure. Treatment of hoarseness due to vocal fold paralysis is generally regarded as being much more successful than treatment of a mucosal defect, such as a scar or sulcus. Outcome is also related to the ability of patients to compensate for any residual deficit. It should be noted that some patients with unilateral laryngeal paralysis have very acceptable voices, even without voice therapy. After all, the larynx is an instrument, and much depends on the ability of the “player.” There are few trumpet virtuosos, but many people who cannot produce even a brief pleasant sound.

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Gayle D. Woodson, MD

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