Supplementary Online Content

Transcription

1 Supplementary Online Content Wang C-C, Chang M-H, Jiang R-S, et al. Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis: a prospective long-term follow-up outcome report. JAMA Otolaryngol Head Neck Surg. Published online January 15, doi: /jamaoto efigure 1 Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injection Procedure for a Patient With Right Vocal Fold Paralysis. efigure 2. Follow-up Summary of the 74 Patients. etable 1. Laryngeal Function Analysis Parameters etable 2. The Scenarios and Secondary Benefits of Obtaining Prognosis From Laryngeal Electromyography During Vocal Fold Injection for Unilateral Vocal Fold Paralysis This supplementary material has been provided by the authors to give readers additional information about their work.

2 efigure 1. Laryngeal electromyography (LEMG)-guided hyaluronic acid (HA) vocal fold injection (VFI) procedure for a patient with right vocal fold paralysis. A. Before VFI, the stroboscopic findings during inspiration. B. Before VFI, the stroboscopic findings during phonation showed the paralyzed right vocal fold was bowed and there was a significant glottal gap. C. The patient s cricothyroid membrane was located by palpation and a 26-gauge monopolar injectable needle electrode was inserted through it into the unaffected left side thyroarytenoid (TA) muscle first. D. The LEMG on the unaffected side showed a normal motor unit potential recruitment pattern. E. The needle electrode was inserted again into the paralyzed right-side TA muscle. The LEMG on the paralyzed side showed abnormal spontaneous activities (fibrillation) while the patient was silent. F. Before completion of LEMG, 1.0 cc of HA was injected via injectable needle electrode into the paralyzed TA muscle. G. After VFI, the stroboscopic findings during inspiration showed the paralyzed right vocal fold was augmented and medialized to the midline of the glottis. H. After VFI, the stroboscopic findings during phonation showed a closed glottis.

3 efigure 2. Follow-up summary of the 74 patients. Fourteen patients were excluded because the follow up was less than 6 months. The final follow-up of the other 60 patients was at least 6 months with a mean of months. Forty-four patients received only one injection, and 16 patients received repeated injection (two for 13 patients and three for 3 patients).

4 etable 1. Laryngeal function analysis parameters Parameters Unit or range Task or calculation NGGA a units glottal gap area(pixels x pixels)/unaffected side membrane vocal fold length2 (pixels x pixels) x 100 MPT b seconds During comfortable phonation with vowel /a/ PQ c ml/s During comfortable phonation with vowel /a/, defined as vital capacity (ml)/maximal phonation time MAFR d ml/s During comfortable phonation with vowel /a/, measured by phenmatachograph GRBAS e 0 to 3 A speech pathologist perceptually graded each patient s voice using the GRBAS scale for overall Grade (G), Roughness (R), Breathiness (B), Asthenia (A) & Strain (S) ("0"= normal, "1"= slight, "2"= moderate, and "3"= severe). VHI f for each scale All patients filled out a 30-item questionnaire, which was used to grade the severity of their voice handicap (Developed by Jacobson et al.). a normalized glottal gap area, b maximal phonation time, c phonation quotient, d mean airflow rate, e Grade, Roughness, Breathiness, Asthenia, and Strain, f Voice Handicap Index

5 etable 2. The scenarios and secondary benefits of obtaining prognosis from laryngeal electromyography (LEMG) during vocal fold injection for unilateral vocal fold paralysis Short-term injection benefit Long-term injection benefit LEMG: poor prognosis Evidence to encourage the patient to have permanent open laryngoplasty after resorption of hyaluronic acid Patient will be happy about sparing the open laryngoplasty. LEMG data could be used for LEMG research. LEMG: good prognosis Patient may consider repeated injection of hyaluronic acid and wait for recovery Patient s symptoms could be relieved before the possible recovery of vocal fold motion. LEMG data could be used in LEMG research.