Factors Directing Treatment Decision‐Making in the Management of Glottic Insufficiency

Objectives To examine factors that direct decisions in the treatment of glottic insufficiency and propose a paradigm that may assist in treatment decision‐making in glottic insufficiency. Methods A retrospective chart review was completed of 73 patients with vocal fold atrophy, presbyphonia, or vocal fold motion impairment, including diagnosis, Voice Handicap Index‐10 (VHI‐10), Voice Problem Impact Scales (VPIS), Glottal Function Index (GFI), Eating Assessment Tool‐10 (EAT‐10), Consensus Auditory Perceptual Analysis of Voice (CAPE‐V), glottal gap size, stimulability, treatment decisions, and outcomes. Univariate and multivariate logistic regression analyses were performed to identify which variables predicted initial treatment recommendation. Mann–Whitney U analysis and Wilcoxon signed‐rank tests were used to analyze outcomes. Results Stimulability (Wald = 27.593; p < 0.001), diagnosis (Wald = 26.496; p < 0.001), CAPE‐V score (Wald = 14.875; p < 0.001), glottal gap size (Wald = 12.045; p < 0.001), and VHI‐10 score (Wald = 10.384; p = 0.001) were the significant predictors of treatment decision. A decision‐making paradigm with these significant variables is proposed, based on the multivariate logistic regression. Utilizing this paradigm, most patients reported improvement from their first‐line treatment (86%, n = 51/59) and some reported symptom resolution (24%, n = 14/59). Patients who completed first‐line treatment demonstrated significant improvement in VHI‐10, GFI, and VPIS scores. Conclusion This study provides preliminary insights into factors that impact treatment decision‐making in the management of glottic insufficiency. The proposed paradigm based on these factors yielded preliminary positive outcomes. Future investigations will continue to work toward an effective, standardized decision‐making model in the management of glottal insufficiency. Level of Evidence 4.