Unilateral Vocal Fold Paralysis and Voice Therapy: Predictors of Long-Term Quality of Life.

To date, little is known about the long-term predictors of quality of life (QoL) in unilateral vocal fold paralysis (UVFP). The main objective of this study was to evaluate the predictors of long-term QoL in UVFP patients submitted to voice therapy (VT) exclusively. Data from patients diagnosed with UVFP who followed a VT program between 2013 and 2019 were reviewed. Video laryngoscopy (VL) records were obtained at the beginning and at the end of VT. To assess QoL, Voice Handicap Index 30 (VHI-30) score was assessed in three temporal frames: before voice therapy (pre-VT), at the last VT session (post-VT), and in the present (cur-VHI). A longitudinal analysis was performed regarding the evolution of QoL and the factors influencing QoL through time were analyzed. Seventy-eight percent of patients had iatrogenic UVFP. The mean time of follow-up after VT was 3.942 years (range 6 months-7 years). There was a significant improvement in QoL through all time points (F (2,88)=72.179, p<0.001), with VHI-30 decrease from the baseline pre-VT to post-VT(p<0.001) and from post-VT to cur-VT (p=0.0013). In the iatrogenic UVFP population, patients starting VT earlier showed better long-term QoL (p=0.023). UVFP patients with dysphagia at presentation showed significantly worse QoL in the late follow-up (p=0.016). Hence, iatrogenic UVFP patients beginning VT rapidly may show better QoL in the future. Also, our results suggest that dysphagia at UVFP onset may predict higher morbidity later in life.

Unilateral Vocal Fold Paralysis and Voice Therapy: Does Age Matter? A Prospective Study With 100 Consecutive Patients.

OBJECTIVE: To use a multidimensional assessment to analyze potential influence of "aging" in the functional outcomes achieved by a group of patients with recent onset of unilateral vocal fold paralysis (UVFP) who underwent voice therapy. DESIGN: Prospective, observational, and cross-sectional study. SETTING: Otolaryngology department, Centro Hospitalar do Porto. PARTICIPANTS: Patients with UVFP who underwent voice therapy. MAIN OUTCOME MEASURES: Data regarding gender, age, side and position of the paralyzed vocal fold, etiology, comorbidities, and Voice Handicap Index (VHI)-30 questions, before and after voice therapy, were collected. Glottal insufficiency was also evaluated, by endoscopic laryngoscopy, before and after voice therapy. RESULTS: A total of 100 patients (76 females and 24 males) with UVFP were included. Mean age was 61.04 years (range: 21-88 years). The mean score of VHI, before and after voice therapy, was statistically different (P < .001) with a lower score after therapy. The score of VHI was not influenced by age (P = .717). However, for each 10-year increase in age, the score of VHI, before and after voice therapy, increased 1.91 and 2.86 units, respectively. As concerns endoscopic findings, 80% of patients exhibited better glottis closure after voice therapy (P < .001), and this was not influenced by age. Nevertheless, for each 10-year increase in age, the chance of endoscopic improvement reduced 3%. CONCLUSIONS: A clear and significant improvement was visible in the endoscopic and self-assessment ratings after rehabilitation by isolated voice therapy. Despite possible anatomical and physiological aging changes in the phonatory system, age did not compromise the successful rate obtained by voice therapy.

[The importance of diffusing capacity as a complementary study to plethysmography in smokers]. / A importância do estudo da difusão alvéolo-capilar, como complemento da pletismografia, na avaliação funcional de fumadores.

UNLABELLED: This study comprised 194 male and female heavy smokers or ex-smokers (>or= 1 pack-year) aged between 20 and 82, whose symptoms varied. Cases were only selected from patients with normal whole-body plethysmography. Subjects with any significant pathology and occupational risk factors were excluded from the study. Varying degrees of symptoms were found and a range of results from normal plethysmography examination, with abnormal levels of alveolar-capillary transfer, determined by the single-breath method to analyse CO (TLCO and TLCO-VA) coefficients. Using the chi-square test for statistical analysis of the sample revealed a significant variation in sensitivity between both parameters (p=0.0001). Possible limitations of using the single-breath method, of were reduced in this study (ventilatory restriction with Vital Capacity <1.5 litres) by the routine plethysmography results seen. Likewise, the presence of alterations in ventilatory distribution was, in principle, minimised by the absence of TLCsb/TLCplet values below 0.85% CONCLUSIONS: Normal plethysmography results in heavy or ex-smokers are not enough to confirm normal respiratory function, as a large percentage of cases present abnormalities in the alveolar-capillary transfer factor for CO. Alveolar limitation was considered not only anatomically, but also from a functional perspective.