Permanent transoral surgery of bilateral vocal fold paralysis: A prospective multi-center trial

Objectives/Hypothesis To describe postoperative adverse events (AEs) and outcomes after transoral surgery for bilateral vocal fold paralysis (BVFP). Study Design Prospective observational multicenter study. Methods Thirty‐six patients with BVFP underwent transoral surgery using standard surgical procedures to unilaterally widen the glottic area. Postoperative adverse events (AEs) including severe adverse events (SAEs) were registered continuously. Pre‐ and 6‐month postoperative evaluations included the 6‐Minute Walk Test, the 36‐Item Short Form Health Survey (SF‐36), the Glasgow Benefit Inventory, the 12‐Item Voice Handicap Index (VHI‐12), and a Fiberoptic Endoscopic Evaluation of Swallowing graded according to the Penetration–Aspiration‐Scale. Results The patients underwent posterior cordotomy, partial arytenoidectomy, or permanent laterofixation as single procedures or in combination. Forty‐seven percent of the patients had postoperative AEs. Dyspnea was the most frequent AE (45%). In 40% of AEs, the events were severe (SAEs), and 72.5% were related to the study intervention. Revision surgery leading to prolonged hospitalization or rehospitalization was necessary in nine cases (25%). Laterofixation was correlated to a decreased risk of AEs (P = 0.042). Six months after surgery, a significant improvement was seen in the SF‐domains: Physical component score (P = 0.008), physical functioning (P = 0.001), physical role (P = 0.031), and vitality (P = 0.032). Concerning the voice handicap, only the VHI‐12 physical subscore showed a decrease (P = 0.005). The total score and other VHI‐12 subscores did not change significantly (all P > 0.05). Conclusion BCVP patients profit from modern transoral surgery for unilateral glottic widening; quality of life is improved; and the voice is preserved. Nevertheless, postoperative complications are frequent. Level of Evidence 2b. Laryngoscope, 125:1401–1408, 2015