The Effect of An Increase of Closed Quotient on Improvement of Voice Quality after Type I Thyroplasty in Patients with Unilateral Vocal Cord Paralysis

일측 성대마비 환자에서 성대내전술 후 성대접촉율의 증가가 음질 개선에 미치는 영향

Purpose : To assess perceptual, acoustic and aerodynamic measure of voice quality in patients with unilateral vocal cord paralysis before and after type I thyroplasty. Methods : The clinical records of patients operated type I thyroplasty in the Departement of otorhinoalryngolgy, Yongdong Severance hospital from November 2001 to November 2003 were reviewed. All patients uderwent a vocal function evaluation including perceptual, acoustic and aerodynamic measures of voice preoperative and on $60^{th}$ postoperative day. The perceptual and acoustic measures were obtained from recording of patients' reading a 'Sanchak' passage. The perceptual evaluation was performed by 2 speech pathologist using a 4-point rating scale. Acoustic parameters(voice range profile low(RAL), voice range profile high(RAH), average fundamental frequency(AFX), closed quotient, harmonic to noise ratio, jitter and shimmer) were investigated by Lx speech studio. Mean flow rate(MFR), subglottic pressure(Psub) and intensity were measured using the Phonatory function analyzer. The maximum phonation time was also measured. The data were statistically analyzed. A paired t-test (p<0.1) was used to compare preoperative and postoperative results. And multiple regression test was used to find which parameter was most correlated to improvement of postoperative voice quality. Results : Among aerodynamic parameters, Psub $(88.11mmH_2O{\rightarrow}58.7mmH_2O)$, MPT(7.87sec${\rightarrow}$12.53sec), MFR (359.8ml/sec${\rightarrow}$161.06ml/sec) were statistically improved. AFx(205.5Hz${\rightarrow}$163.27Hz), AQx(23.9%${\rightarrow}$48.3%), RAL, RAH. Jotter and shimmer were improved. In multiple regression test, AFx and AQx was noted as the two meost correlated parameters to improvement of postoperative breathiness. But general grade of voice quality was more correlated to Psub and shimmer. Conclusion : Vocal fold medialization procedures effectively reduce glottic gap. Increasing of contact area of both vocal folds induced improvement in aerodynamic parameters and leaded stabilizing of vocal fold vibration. That effect results in improvement in acoustic parameters (shimmer, jitter, signal-to-noise ratio, voice range profile) and voice quality.