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

Helen Blackshaw, Paul Carding, Marcus Jepson, Marina Mat Baki, Gareth Ambler, Anne Schilder, Stephen Morris, Aneeka Degun, Rosamund Yu, Samantha Husbands, Helen Knowles, Chloe Walton, Yakubu Karagama, Kate Heathcote, Martin Birchall

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish
Article number016871
JournalBMJ Open
Volume7
Issue number9
DOIs
Publication statusPublished - 1 Sep 2017

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Laryngoplasty
Vocal Cords
Paralysis
Randomized Controlled Trials
Arytenoid Cartilage
Voice Quality
Speech Therapy
Research Ethics Committees
Feasibility Studies
Airway Obstruction
Deglutition
Ethics
Running
Dyspnea
Publications

Keywords

  • adult otolaryngology
  • clinical trials
  • laryngology
  • otolaryngology
  • speech pathology

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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, Helen; Carding, Paul; Jepson, Marcus; Mat Baki, Marina; Ambler, Gareth; Schilder, Anne; Morris, Stephen; Degun, Aneeka; Yu, Rosamund; Husbands, Samantha; Knowles, Helen; Walton, Chloe; Karagama, Yakubu; Heathcote, Kate; Birchall, Martin.

In: BMJ Open, Vol. 7, No. 9, 016871, 01.09.2017.

Research output: Contribution to journalArticle

Blackshaw, H, Carding, P, Jepson, M, Mat Baki, M, Ambler, G, Schilder, A, Morris, S, Degun, A, Yu, R, Husbands, S, Knowles, H, Walton, C, Karagama, Y, Heathcote, K & Birchall, M 2017, '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', BMJ Open, vol. 7, no. 9, 016871. https://doi.org/10.1136/bmjopen-2017-016871
Blackshaw, Helen ; Carding, Paul ; Jepson, Marcus ; Mat Baki, Marina ; Ambler, Gareth ; Schilder, Anne ; Morris, Stephen ; Degun, Aneeka ; Yu, Rosamund ; Husbands, Samantha ; Knowles, Helen ; Walton, Chloe ; Karagama, Yakubu ; Heathcote, Kate ; Birchall, Martin. / 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. In: BMJ Open. 2017 ; Vol. 7, No. 9.
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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.",
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