Odynophonia, or pain associated with voice use, is a relatively uncommon manifestation of glottal insufficiency related to vocal fold motion impairment (VFMI). Its incidence is approximately 15% in patients with vocal fold paresis. Medialisation laryngoplasty (ML) was popularised by Isshiki in 1974 and remains the gold standard for the long-term treatment of hoarseness related to glottal insufficiency. Medialisation laryngoplasty is also commonly performed for aspiration and dysphagia related to glottal insufficiency from vocal fold motion impairment. In this study authors speculated that patients with a chief complaint of odynophonia may achieve pain relief with medialisation laryngoplasty, even when the degree of vocal impairment is mild or nonexistent. A retrospective review of medical records of eight patients from two tertiary care laryngology centres who underwent medialisation laryngoplasty for the chief complaint of odynophonia was conducted. Pain with voice use was the chief complaint for all patients in the study, and relief of their pain was assessed by patient self-report following intervention. Preoperative Voice Handicap Index 10 and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores were compared with postoperative scores. CAPE-V is an auditory-perceptual evaluation tool that uses a visual analogue scale from 0 to 100 to rate overall severity, roughness, breathiness, strain, pitch and loudness. CAPE-V assessments were performed by certified speech-language pathologists specialising in the evaluation of voice disorders. Eight patients underwent ML for the chief complaint of odynophonia over a two-year period. Mean follow-up time was 14.1 months. Dysphonia was not the primary complaint in any of the cases reviewed. Gore-Tex was used for the ML in six patients, and Silastic was used in the other two patients. All eight patients experienced relief of odynophonia following ML. The presence of pain or discomfort may be underappreciated by the clinician who is focused primarily on voice quality. Compensatory supraglottic hyperfunction is common in patients with glottal insufficiency, and the resulting muscle strain is presumed to be the predominant underlying cause of odynophonia in these patients. Authors have hypothesised that relief of odynophonia is a result of reduced muscle strain in most of these patients. The conclusions from this study should be made with caution, limited by a small number of patients and retrospective design. 

Medialization laryngoplasty for odynophonia.
Kupfer RA, Merati AL, Sulica L.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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