A Novel Approach for Thyroplasty Type 1, With Prolene Mesh. A Prospective Study.
Primary Purpose
Vocal Cord Paralysis, Phonasthenia, Presbylarynges
Status
Completed
Phase
Not Applicable
Locations
Pakistan
Study Type
Interventional
Intervention
Prolene Mesh Vocal Cord Medialization Implant
Sponsored by
About this trial
This is an interventional treatment trial for Vocal Cord Paralysis focused on measuring Voice Rehabilitation, Vocal Medialization, Prolene mesh implant
Eligibility Criteria
Inclusion Criteria:
- Age more than 15 years
- Vocal cord paralysis
Exclusion Criteria:
- Patients with neoplasms
- Trauma
- Muscular dystrophies
Sites / Locations
- ENT Departments
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Prolene Mesh Implant
Arm Description
The Group of Patients who were offered Prolene mesh Laryngeal implants for Vocal Cord Medialization.
Outcomes
Primary Outcome Measures
Change in Mean Phonation Time
Pre and postoperative voices will be recorded with a standard microphone at 15cm distance from the mouth in a quiet room. Maximum phonation time (MPT) while vocalizing the vowel sound 'eee' will be measured in seconds. Maximum three attempts will be allowed to each patient and the better score of the three will be recorded in the data.
Change in Maximum Words Count
Pre and postoperative voices will be recorded with a standard microphone at 15cm distance from the mouth in a quiet room. Maximum words count (MWC) in a single breath (counting numbers) will be recorded pre and post operatively. Maximum three attempts will be allowed to each patient and the better score of the three will be recorded in the data.
Change in Voice Quality on Visual Analogue Score
For subjective assessment of voice quality Visual (1-10) analogue score (VAS) will be used both pre and postoperatively. Score 1 will be the score for lowest and 10 being the best score for voice quality.
Secondary Outcome Measures
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04458818
Brief Title
A Novel Approach for Thyroplasty Type 1, With Prolene Mesh. A Prospective Study.
Official Title
A Novel Approach for Thyroplasty Type 1, With Prolene Mesh. A Prospective Study.
Study Type
Interventional
2. Study Status
Record Verification Date
April 2021
Overall Recruitment Status
Completed
Study Start Date
May 1, 2020 (Actual)
Primary Completion Date
January 30, 2021 (Actual)
Study Completion Date
January 30, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Muhammad Rashid
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Larynx performs important functions of the aero-digestive tract, it has vital role in control of breathing, phonation, deglutition and protection of lower respiratory tract from aspiration. Vocal cord paralysis is a common and at times debilitating laryngeal dysfunction that has great social and economic impact on patients life. Medialization thyroplasty (MT), if done accurately and up to the expectations of the patient is very rewarding. However different materials with some modifications in the technique of the classical Isshiki type 1 thyroplasty is in practice, each with its own profile of benefits and disadvantages. Most of them are costly and out of reach of general population. In this regard, we aim to test a prolene mesh implant, which is easily available and can be placed with relative ease.
Detailed Description
Introduction: Larynx performs important functions of the aero-digestive tract, it has vital role in control of breathing, phonation, deglutition and protection of lower respiratory tract from aspiration. The function of Vocal cord is central to all the Laryngeal functions, even unilateral paralysis can have profound effect on overall laryngeal functionality especially in sound production. Around 80% of all the jobs in the world are somehow dependent upon social communication. Vocal cord paralysis is a common and at times debilitating laryngeal dysfunction that has great social and economic impact on patients life. Medialization thyroplasty (MT), if done accurately and up to the expectations of the patient is very rewarding. However different materials with some modifications in the technique of the classical Isshiki type 1 thyroplasty is in vogue, each with its own profile of benefits and disadvantages. In this regard a large variety of complex materials are in use, which are not routinely available in developing countries and some of them have not been cleared by the host countries medical authorities. Most of them are costly and out of reach of general population. In this regard, we aim to test a prolene mesh implant, which is easily available and can be placed with relative ease. We recommend some modifications in the original technique, which would not require the complex measurements and costly equipment. Even it can be performed without fiber-optic laryngoscope guidance. Prolene is already in use in wide range of procedures worldwide, approved by Federal drug administration in 1997 but it has never been used in larynx. We intend to explore the efficacy of prolene mesh as an implant for vocal cord medialization in terms of patient satisfaction and voice outcome.
Objective: To evaluate a new approach of vocal cord medialization using prolene mesh as an implant material.
Study Design: Interventional, prospective study.. Place and Duration of study: Ent departments of multiple tertiary care hospitals of Pakistan from Jun 2020 and onwards.
Materials and Methods: Patients of age 15 years onwards and with vocal cord paralysis/ paresis due to multiple causes would included in the study. Patients with neoplasm, trauma and underlying muscular dystrophy are to be excluded. All patients will be counselled properly and given the choice of intervention by prolene mesh implant. Consenting patients will be subjected to routine blood investigations with fiber optic laryngoscopy and imaging with Computerized Tomography scan (where applicable). Procedure will be performed under local anesthesia with mild sedation, so that the patient will remain vocally responsive for the assessment of voice and breathing intraoperatively. Pre and postoperative voices will be recorded with a standard microphone at 15cm distance from the mouth in a quiet room. Maximum phonation time (MPT) while vocalizing the vowel sound 'eee' and Maximum words count (MWC) in a single breath (counting numbers) will be recorded pre and post operatively. Maximum three attempts will be allowed to each patient and the better score of the three will be recorded in the data. For subjective assessment of voice quality Visual (1-10) analogue score (VAS) will be used both pre and postoperatively. For objective assessment of patients a customized Voice Handicap Index (VHI-10) will be used.
Modified VHI-10 Questionnaire
My voice makes it difficult for people to hear me. 0 1 2 3 4 5
I run out of air when I talk. 0 1 2 3 4 5
People have difficulty understanding me in noisy room. 0 1 2 3 4 5
I use a great deal of effort to speak. 0 1 2 3 4 5
My family has difficulty hearing me when I call them throughout the house. 0 1 2 3 4 5
I use phone less often than I would like to. 0 1 2 3 4 5
I am tense when I am talking to others because of my voice. 0 1 2 3 4 5
I tend to avoid groups of people because of my voice. 0 1 2 3 4 5
People seem irritated with my voice. 0 1 2 3 4 5
People ask what's wrong with my voice. 0 1 2 3 4 5 VHI : Voice Handicap Index 0 = never, 1 = almost never (occasionally), 2 = sometimes, 3 = almost always, 4 = always Fig 1.1 Modified Voice Handicap Index (VHI-10)
Hospital ethical committee's approval will be obtained. The surgery will be performed under local anesthesia (lignocaine with adrenaline 2%) and procedural sedation with propofol 25-100mcg/kg/min (only sedative dose) will be administered, so that the patient remains vocally responsive during the procedure. Incision will be made at the lower border of thyroid cartilage under aseptic measures. Skin flaps will be raised in sub-platysmal plane, strap muscles will be separated in the midline to expose the laryngeal cartilaginous framework. A simple laryngeal window approach will be used to place the Ethicon prolene mesh 6 x 6 cm Swiss roll, secured with prolene 2/0 suture trimmed to the required size. Post op voice analysis will be done on 14th post-operative day. Routine monthly follow up for 3 months will be advised after that.
The results will be analyzed using Internal IBM SPSS Statistics version 20. Variables defined would be compared between the preoperative and postoperative groups. For normal data paired sample t-test would be used and for abnormally distributed data non parametric t-test would be used. P-value of less than 0.05 will be taken as significant.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Vocal Cord Paralysis, Phonasthenia, Presbylarynges, Idiopathic Vocal Cord Paralysis, Ca Larynx
Keywords
Voice Rehabilitation, Vocal Medialization, Prolene mesh implant
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
The single group will be implanted with Prolene mesh made into Swiss rolls and placed in Laryngeal Window between the cartilage and inner periosteum,
Masking
None (Open Label)
Masking Description
No Masking. Patients in one arm are provided with prolene mesh implant, and is known by the patient, health care provider and the assessor.
Allocation
N/A
Enrollment
39 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Prolene Mesh Implant
Arm Type
Experimental
Arm Description
The Group of Patients who were offered Prolene mesh Laryngeal implants for Vocal Cord Medialization.
Intervention Type
Procedure
Intervention Name(s)
Prolene Mesh Vocal Cord Medialization Implant
Intervention Description
The surgery will be performed under local anesthesia (lignocaine with adrenaline 2%) and procedural sedation with propofol 25-100mcg/kg/min (only sedative dose) will be administered, so that the patient remains vocally responsive during the procedure. Incision will be made at the lower border of thyroid cartilage under aseptic measures. Skin flaps will be raised in sub-platysmal plane, strap muscles will be separated in the midline to expose the laryngeal cartilaginous framework. A simple laryngeal window approach will be used to place the Ethicon prolene mesh 6 x 6cm Swiss roll, secured with prolene 2/0 suture trimmed to the required size. Post op voice analysis will be done on 7th day and 14th post-operative day. Monthly follow up will be advised after that.
Primary Outcome Measure Information:
Title
Change in Mean Phonation Time
Description
Pre and postoperative voices will be recorded with a standard microphone at 15cm distance from the mouth in a quiet room. Maximum phonation time (MPT) while vocalizing the vowel sound 'eee' will be measured in seconds. Maximum three attempts will be allowed to each patient and the better score of the three will be recorded in the data.
Time Frame
Preoperative and 14th Postoperative day
Title
Change in Maximum Words Count
Description
Pre and postoperative voices will be recorded with a standard microphone at 15cm distance from the mouth in a quiet room. Maximum words count (MWC) in a single breath (counting numbers) will be recorded pre and post operatively. Maximum three attempts will be allowed to each patient and the better score of the three will be recorded in the data.
Time Frame
Preoperative and 14th Postoperative day
Title
Change in Voice Quality on Visual Analogue Score
Description
For subjective assessment of voice quality Visual (1-10) analogue score (VAS) will be used both pre and postoperatively. Score 1 will be the score for lowest and 10 being the best score for voice quality.
Time Frame
Preoperative and 14th Postoperative day
10. Eligibility
Sex
All
Minimum Age & Unit of Time
15 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Age more than 15 years
Vocal cord paralysis
Exclusion Criteria:
Patients with neoplasms
Trauma
Muscular dystrophies
Facility Information:
Facility Name
ENT Departments
City
Kharian
State/Province
Punjab
ZIP/Postal Code
500090
Country
Pakistan
12. IPD Sharing Statement
Plan to Share IPD
Undecided
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A Novel Approach for Thyroplasty Type 1, With Prolene Mesh. A Prospective Study.
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