Dysphonia and dysphagia after anterior cervical decompression

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Object.

In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function.

Methods.

The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology—Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography.

Results.

Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome.

Conclusions.

Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD. Recurrent laryngeal nerve damage detected by EMG is not rare. Pre-and postoperative laryngeal examination of ACD patients should be considered.

Abbreviations used in this paper:ACD = anterior cervical decompression; EMG = electromyography; HRQOL = health-related quality of life; HUCH = Helsinki University Central Hospital; VAS = visual analog scale.

Article Information

Address reprint requests to: Hanna Tervonen, M.D., Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Central Hospital, P.O. Box 220 FIN-00029 HUS, Helsinki, Finland. email: hanna.tervonen@hotmail.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flow chart demonstrating patient groups and the research protocol.

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    Box plot of subjective handicap of persistent dysphonia and dysphagia as measured on the VAS, with the early and late patient groups combined.

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    Graph demonstrating the 15D profile of the early group before and 3 months after ACD. (Asterisk denotes significant improvement from baseline at the p < 0.05 level.

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    Bar graph of the HRQOL data. The y axis shows the 15D scores on a scale of 0 to 1.

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