Voice outcomes following adult cricotracheal resection§

Authors

  • Jeffrey J. Houlton MD,

    1. Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
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  • Alessandro de Alarcon MD, MPH,

    1. Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
    2. Center for Pediatric Voice Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
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  • Kaalan Johnson MD,

    1. Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
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  • Jareen Meinzen-Derr PhD, MPH,

    1. Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
    2. Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
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  • Susan Baker Brehm PhD, CCC-SLP,

    1. Center for Pediatric Voice Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
    2. Department of Speech Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
    3. Department of Speech Pathology and Audiology, Miami University, Oxford, Ohio, U.S.A.
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  • Barbara Weinrich PhD, CCC-SLP,

    1. Center for Pediatric Voice Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
    2. Department of Speech Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
    3. Department of Speech Pathology and Audiology, Miami University, Oxford, Ohio, U.S.A.
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  • Ravindhra G. Elluru MD, PhD

    Corresponding author
    1. Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
    • Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 2018, Cincinnati, Ohio 45229
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  • This submission was presented at the annual COSM/ALA meeting in Chicago, April 27, 2011, and is the winner of the ALA resident research award.

  • The authors have no financial disclosures for this article.

  • §

    The authors have no conflicts of intersts to disclose.

Abstract

Objectives:

Cricotracheal resection (CTR) is an effective treatment for moderate-to-severe laryngotracheal stenosis (LTS) in adults. However, one of the potentially significant sequela of this procedure is postoperative dysphonia and permanent voice alteration. The objective of this study is to characterize voice changes in adult patients with subglottic stenosis who have undergone CTR.

Study Design:

Retrospective case-series.

Methods:

Acoustic, aerodynamic, and consensus auditory-perceptual evaluation of voice (CAPE-V) data were reviewed for consecutive adult patients undergoing CTR and perioperative voice evaluation from 2000 to 2010.

Results:

Sixteen patients (median age 44 years, 94% female) underwent CTR and voice evaluation during the study period. Thirteen patients underwent postoperative evaluation and had a mean overall CAPE-V score of 47.5/100, mean fundamental frequency (F0) of 156.7 Hz, average estimated subglottic pressure of 10.0 cm H2O, and an average airflow of 224 mL/sec. Seven patients underwent pre- and postoperative evaluations and had a significant reduction in mean F0 (206.5 vs. 151.1 Hz, P = .002) and mean F0 for connected speech (194.9 vs. 152.7 Hz, P = .047), but not in median intensity, range, estimated subglottic pressure, or airflow. Median overall CAPE-V scores worsened, but did not reach statistical significance (12 vs. 61.5, P = .28). Seventy-one percent of patients underwent an increase in acoustic signal typing postoperatively.

Conclusions:

Although CTR is an effective treatment for adult LTS, it results in significant alteration of the adult voice. In particular, CTR decreases the fundamental frequency of connected speech and vowel phonation and changes the acoustic signal type. Patients should be counseled about these likely voice alterations prior to undergoing surgery.

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