Staged Interventions for Vocal Fold Paresis and Paralysis: A Proposed Decision Paradigm for Type 1 Thyroplasty

OBJECTIVE: To evaluate the effect of staged interventions for vocal fold paresis and paralysis on objective and subjective laryngeal function to inform clinical decision-making. METHODS: A retrospective chart review of approximately 1000 patients was performed at a quaternary care office to identify patients who had undergone type 1 thyroplasty between January 1990 and April 2024. Patients who had undergone all laryngeal surgeries by the senior author, had available operative reports, had vocal fold paresis and/or paralysis, and had high-quality pre- and postoperative strobovideolaryngoscopy (SVL) examinations were sorted into the thyroplasty-performed-first group or the other-intervention-performed-first group. Patient characteristics, voice quality, and laryngeal function measures were collected pre- and postoperatively. SVL examinations underwent blind review by three raters to assess glottic closure. Glottic gap measurements were performed using ImageJ, and statistical analyses were conducted using SPSS. RESULTS: Of the 177 patients who had undergone type 1 thyroplasty, 72 met inclusion criteria. The thyroplasty-performed-first group included 45 patients, and the other-intervention-performed-first group included 27 patients. Older age was more prevalent in the thyroplasty-performed-first group (t (72) = 2.287, P = 0.025). Patients in the thyroplasty-performed-first group had undergone a second medialization procedure 3.6 years (median) later (3.3 times longer) than those in the other group. However, there was no significant difference between the groups in glottic gap closure rating, glottic gap measurement, preoperative subjective voice quality, or objective voice quality measurements. CONCLUSION: Staged procedures may affect voice outcomes. In patients who had undergone thyroplasty, the time until a second medialization procedure increased if the thyroplasty was the first laryngeal intervention performed.