Prospective multi-arm evaluation of surgical treatments for vocal fold scar and pathologic sulcus vocalis.

Objectives/Hypothesis: The purpose of this study was to compare the clinical effectiveness of type I thyroplasty, injection laryngoplasty, and graft implantation for the treatment of vocal fold scar and pathologic sulcus vocalis. Study Design: Prospective, multi-arm, quasi-experimental research design.Methods: Twenty-eight patients with newly diagnosed vocal fold scar and/or pathologic sulcus vocalis were assigned to one of three treatment modalities: type I thyroplasty (n ¼ 9), injection laryngoplasty (n ¼ 9), and graft implantation (n ¼ 10). Psychosocial, auditory perceptual, acoustic, aerodynamic, and videostroboscopic data were collected pretreatment and at1, 6, 12, and 18 months posttreatment. Results: Type I thyroplasty and graft implantation both resulted in reduced voice handicap with no concomitant improvement in auditory-perceptual, acoustic, aerodynamic, or vocal fold physiologic performance. Injection laryngoplasty resulted in no improvement on any vocal function index. Patients who underwent graft implantation exhibitedthe slowest improvement trajectory across the 18-month follow-up period. Conclusions: A persistent challenge in this area is that no single treatment modality is successful for the majority of patients, and there is no evidence-based decision algorithm for matching a given treatment to a given patient.Progress therefore requires the identification and categorization of predictive clinical features that can drive evidence-based treatment assignment. [ABSTRACT FROM AUTHOR]