Prospective multi‐arm evaluation of surgical treatments for vocal fold scar and pathologic sulcus vocalis

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Abstract
Objectives/Hypothesis: The purpose of this study was to compare the clinical effectiveness of type I thyroplasty, injection laryngoplasty, and graft implantation for the treatment of vocal fold scar and pathologic sulcus vocalis.Study Design: Prospective, multi‐arm, quasi‐experimental research design.Methods: Twenty‐eight patients with newly diagnosed vocal fold scar and/or pathologic sulcus vocalis were assigned to one of three treatment modalities: type I thyroplasty (n = 9), injection laryngoplasty (n = 9), and graft implantation (n = 10). Psychosocial, auditory‐perceptual, acoustic, aerodynamic, and videostroboscopic data were collected pretreatment and at 1, 6, 12, and 18 months posttreatment.Results: Type I thyroplasty and graft implantation both resulted in reduced voice handicap with no concomitant improvement in auditory‐perceptual, acoustic, aerodynamic, or vocal fold physiologic performance. Injection laryngoplasty resulted in no improvement on any vocal function index. Patients who underwent graft implantation exhibited the slowest improvement trajectory across the 18‐month follow‐up period.Conclusions: A persistent challenge in this area is that no single treatment modality is successful for the majority of patients, and there is no evidence‐based decision algorithm for matching a given treatment to a given patient. Progress therefore requires the identification and categorization of predictive clinical features that can drive evidence‐based treatment assignment.

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