Office Based Trans-nasal Fiber Laser Thyroarytenoid Myectomy under local anaesthesia for treating patients of Adductor Spasmodic Dysphonia –our Initial Experience

Objective:- To present our initial experience with a new surgical technique of Office Based Trans nasal Endoscopic Fiber Laser assisted Thyroarytenoid Myectomy under local anaesthesia for patients of Adductor Spasmodic Dysphonia (ASD ) when associated either with high risk for general anaesthesia or with Difficult Laryngeal Exposure (DLE) in a OR setting for Trans-oral Endoscopic CO2 Laser assisted Thyroarytenoid Myectomy.

Methods 5 patients of ASD in the age group of 30 to 76 years attending between July 2022 and May 2023 were operated by the new surgical technique . 3 of them were denied for Trans-oral endoscopic surgery due to associated comorbidity and
high risk for general anaesthesia and in 2 patients the procedure was abandoned due to Difficult Laryngeal Exposure in OR . All the patients responded to Botox Injections earlier with inconsistent results and all were reluctant for cervical approach. Voice Handicap Index (VHI) and Videolaryngostroboscopy observed as parameters during the pre and post operative periods

Results Average postoperative period of follow-up period was 8 months. The vocal improvement started one month after the surgery and persistent during the entire follow up period. A significant improvement in VHI was observed in all cases
Videolaryngostroboscopy was showing marked reduction in vocal fold hyper adduction and AP glottal compression in 3 cases. There was granuloma formation in one case which subsided eventually in 2 months time

Conclusion The present study of Trans-nasal Endoscopic Thyroarytenoid Myectomy is confined to very limited number of patients of ASD either with high risk for general anaesthesia or Difficult Laryngeal exposure for Trans oral approach .A larger series over a longer follow up period will further help to accurately assess the efficacy of this procedure

Key Words:- Adductor Spasmodic Dysphonia, Thyroarytenoid Myectomy,
Phaniendra.Kumar.V M.S.,Director and chief Consultant, (+91-9848134018., drvoicep@hotmail.com).,
Ravindranath Tagore. A ., M.B.B.S., D.L.O.,Research Associate (91-98848090108.,tagoreare@gmail.com).,
Satya Sai.K ., M.S ., Fellow., (+91-9396666966 ., kapavarapusatyasai@gmail.com
Sri Sathya Sai ENT and Melody Voice Clinic,4/2 Brodiepet, Guntur-522002, A.P., India
Corresponding author :- Phaniendrakumar.V +91-9848134018., drvoicep@hotmail.com