Clinical Utility of Aerodynamic Measures in Vocal Fold Augmentation Outcomes

Abstract

Objective: Glottic insufficiency can result in respiratory-laryngeal dysfunction that contributes to dysphonia. Instrumental assessments complement patient- and clinician-reported evaluations. Aerodynamic measurements provide quantitative data to characterize phonatory function. This study aimed to determine whether preoperative phonatory aerodynamic measures are associated with outcomes following vocal fold medialization for glottic insufficiency. Methods: A retrospective review of patients who underwent injection laryngoplasty or type 1 thyroplasty at the Emory Voice Center from 2022 to 2024 were analyzed for baseline and post-procedure phonatory aerodynamic measures (mean airflow during voicing [MADV]), breaths while speaking, speaking duration, and patient-reported outcomes (voice handicap index-10) to assess changes across procedures (N = 98). Patients underwent one or multiple procedures, but data were not stratified by type or sequence. Results: Patients who underwent a second augmentation procedure had significantly higher baseline MADV (M = 0.49 L/s, SD = 0.25) than those who had one procedure (M = 0.32 L/s, SD = 0.23; p = 0.01), and took fewer breaths to read a standard passage from baseline (M = 13.1, SD = 7.2) to post-procedure 1 (M = 9.9, SD = 4.5; p = 0.02) than the 1-procedure cohort. Across groups, VHI-10 scores improved from baseline (M = 29.9, SD = 8.7) to post-procedure 1 (M = 21.6, SD = 10.7; p = 0.0008), and further after procedure 2 (M = 10.9, SD = 10.5; p = 0.02). Conclusion: Higher baseline MADV was linked to requiring multiple procedures, suggesting it may help predict the number needed to achieve glottic sufficiency. Post-treatment improvements in airflow and the number of breaths while speaking highlight the clinical value of aerodynamic assessments in planning and evaluating intervention outcomes.