This retrospective case series explores the voice outcomes for 21 patients diagnosed with presbylaryngis who underwent bilateral medialisation thyroplasty at a university medical centre in Portland, Oregon, USA. Silastic was implanted in 17 patients; hydroxyapatite in four. Significant improvements were found in Voice Handicap Index scores, maximum phonation time, consensus auditory-perceptual evaluation of voice and clinician rating of vocal quality. Blinded raters also noted a significant improvement in audio and videostroboscopic samples postoperatively. No operative complications were encountered, and median length of admission was one night. The results of this study do undoubtedly show that bilateral medialisation thyroplasty is a safe and effective treatment option for presbyphonia. What this study doesn’t conclusively demonstrate, however, is whether this treatment option provides better outcomes than voice therapy alone, or bilateral vocal cord medialisation injections. Admittedly, 12 patients had already undergone voice therapy prior to surgery; this had most commonly been stopped due lack of patient-perceived improvement. Nine had also undergone prior injection medialisation. Nevertheless, until a prospective RCT is performed comparing the different treatment modalities for presbyphonia, bilateral thyroplasty is likely to remain a treatment option of last resort, especially in a publicly-funded healthcare system, given its expense and invasiveness relative to the alternatives. Moreover, many elderly patients are not seeking a reversal of their voice changes but rather the reassurance that their symptoms are not due to more serious pathology such as a malignancy.
Bilateral medialisation thyroplasty for presbylaryngis
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