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Does laryngeal reinnervation or type I thyroplasty give better voice results for patients with unilateral vocal fold paralysis (VOCALIST): study protocol for a feasibility randomised controlled trial

Blackshaw H 1 , Carding P 2 , Jepson M 3 , Mat Baki M 4 , Ambler G 5 , Schilder A 1 Show all authors , Morris S 6 , Degun A 1 , Yu R 7 , Husbands S 3 , Knowles H 8 , Walton C 2 , Karagama Y 9 , Heathcote K 10 , Birchall M 1

Affiliations 

  • 1 Ear Institute, University College London, London, UK
  • 2 School of Allied Health, Australian National Catholic University, North Sydney, New South Wales, Australia
  • 3 School of Social and Community Medicine, University of Bristol, Bristol, UK
  • 4 Faculty of Medicine, National University of Malaysia, Malaysia
  • 5 Statistical Science, University College London, London, UK
  • 6 Department of Applied Health Research, University College London, London, UK
  • 7 UCL Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
  • 8 Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust, London, UK
  • 9 Department of Otolaryngology-Head & Neck Surgery, Manchester Royal Infirmary, Manchester, UK
  • 10 Department of Otolaryngology, Poole Hospital, Poole, UK
BMJ Open, 2017 Sep 29;7(9):e016871.
PMID: 28965097 DOI: 10.1136/bmjopen-2017-016871

Abstract

INTRODUCTION: A functioning voice is essential for normal human communication. A good voice requires two moving vocal folds; if one fold is paralysed (unilateral vocal fold paralysis (UVFP)) people suffer from a breathy, weak voice that tires easily and is unable to function normally. UVFP can also result in choking and breathlessness. Current treatment for adults with UVFP is speech therapy to stimulate recovery of vocal fold (VF) motion or function and/or injection of the paralysed VF with a material to move it into a more favourable position for the functioning VF to close against. When these therapies are unsuccessful, or only provide temporary relief, surgery is offered. Two available surgical techniques are: (1) surgical medialisation; placing an implant near the paralysed VF to move it to the middle (thyroplasty) and/or repositioning the cartilage (arytenoid adduction) or (2) restoring the nerve supply to the VF (laryngeal reinnervation). Currently there is limited evidence to determine which surgery should be offered to adults with UVFP.

METHODS AND ANALYSIS: A feasibility study to test the practicality of running a multicentre, randomised clinical trial of surgery for UVFP, including: (1) a qualitative study to understand the recruitment process and how it operates in clinical centres and (2) a small randomised trial of 30 participants recruited at 3 UK sites comparing non-selective laryngeal reinnervation to type I thyroplasty. Participants will be followed up for 12 months. The primary outcome focuses on recruitment and retention, with secondary outcomes covering voice, swallowing and quality of life.

ETHICS AND DISSEMINATION: Ethical approval was received from National Research Ethics Service-Committee Bromley (reference 11/LO/0583). In addition to dissemination of results through presentation and publication of peer-reviewed articles, results will be shared with key clinician and patient groups required to develop the future large-scale randomised controlled trial.

TRIAL REGISTRATION NUMBER: ISRCTN90201732; 16 December 2015.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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