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Optimal arytenoid adduction based on quantitative real-time voice analysis

Authors

  • Matthew R. Hoffman BS,

    1. University of Wisconsin–Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, Madison, Wisconsin, U.S.A.
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  • Ketan Surender BS,

    1. University of Wisconsin–Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, Madison, Wisconsin, U.S.A.
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  • William J. Chapin,

    1. University of Wisconsin–Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, Madison, Wisconsin, U.S.A.
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  • Rachel E. Witt,

    1. University of Wisconsin–Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, Madison, Wisconsin, U.S.A.
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  • Timothy M. McCulloch MD,

    1. University of Wisconsin–Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, Madison, Wisconsin, U.S.A.
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  • Jack J. Jiang MD, PhD

    Corresponding author
    1. University of Wisconsin–Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, Madison, Wisconsin, U.S.A.
    • University of Wisconsin–Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, 1300 University Avenue, 5745 Medical Sciences Center, Madison, WI 53706
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  • The authors have no financial disclosures for this article.

  • The authors have no conflicts of interest to declare.

Abstract

Hypothesis:

The optimal degree of arytenoid rotation for arytenoid adduction (AA) can be determined using quantitative real-time voice analysis.

Study Design:

Repeated measures with each larynx serving as its own control.

Methods:

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 (VE), 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.

Results:

Mean optimal angle of arytenoid adduction was 151.4 ± 2.5°. VE differed significantly across experimental conditions (P = .003). Optimal AA produced the highest VE 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.

Conclusions:

VE 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.

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