A Closer Look at Medialization Laryngoplasty in the Elderly

Medialization laryngoplasty is a well-established treatment for the management of vocal fold paralysis and glottis insufficiency. However, until recently, there has been little focus on the experience of elderly patients undergoing the operation.

The Cleveland Clinic Head & Neck Institute decided to take a closer look at medialization in elderly patients, a population that can be at risk for depression and social isolation as well as comorbidities, which may can cause patients to shy away from the procedure.

“We know that vocal cord paralysis can cause significant vocal handicap, which can lead to decreased quality of life and social isolation,” says voice and swallowing rehabilitation specialist Paul C. Bryson, MD, Director of the Cleveland Clinic Voice Center. “And we know that medialization laryngoplasty is a successful surgery for voice rehabilitation. But because elderly patients may have increased comorbidities and frailty, they may be hesitant to pursue elective surgery.”

Patients aged 65 and older undergoing medicalization laryngoplasty at Cleveland Clinic’s Voice Center were retrospectively reviewed from 2008 to 2015. Indications were recorded along with medical comorbidities. Outcomes included outpatient versus inpatient care postoperatively, surgical complications, voice outcome measures, revision rate and follow-up.

The center performed the procedure on 113 elderly patients (aged 65 to 92, average age 73) between 2008 and 2015. Postoperatively, voice handicap index scores improved an average of 50 percent, and complete glottic closure was observed in 85 percent of patients (N=96). The overall surgical complication rate was less than 7 percent; the incidence of major surgical complications was 1 percent. Three patients (just 3 percent) required revision medialization surgery.

“The vast majority had improved voice-related quality of life and low incidence of complications,” says Dr. Bryson. “And low dose aspirin, which many elderly patients take, was not associated with increased complications for the procedure.”

The conclusion was that medialization laryngoplasty is a safe, viable and successful option for elderly patients with vocal handicap. With few exceptions, patients achieved a clinically meaningful improvement in their voice-related quality of life with low complication rate.