الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 207 |  |  |
| | | from | 207 | | |
Abstract
Unilateral vocal fold paralysis (UVFP) has an important implication on the larynx’s role in airway protection, respiration, phonation and swallowing. It is the most common neurological laryngeal disorder. There is a wide variation in the incidence of UVFP, depending on the etiology. Much of the research has focused on its implication on voice, and there is limited data on its impact on swallowing, despite its common occurrence. It is an important secondary outcome which affects the patient’s life. It is not a simple matter of impaired glottic closure and should be managed in a multidisciplinary manner to optimize a patient’s outcome. The aim of this work was to evaluate the management of oropharyngeal dysphagia in cases of UVFP by either behavioral readjustment therapy (BRAT) or vocal fold injection in order to provide the best management technique regarding safety and effectiveness in these patients. The present study was conducted on twenty consecutive patients presented with oro-pharyngeal dysphagia due to UVFP (included 11 males and 9 females with ages ranging from 20-67 years) who were admitted at the phoniatric clinic of Tanta University Hospital. The patients were divided randomly into two groups: • group I: 10 patients received behavioral readjustment therapy. • group II: 10 patients received vocal fold injection. All the candidates underwent appropriate assessment for swallowing clinically and endoscopically by FEES pre intervention then 1week and 3 months post-intervention. The results demonstrated that there was a significant improvement in injection group vs Behavioral group in 1 week and 3 months follow up after intervention regarding the glottal gap size. Regarding presence of residue in vallecula and pyriform fossa, the results showed that there was no significant difference between both groups 1w and 3m post intervention. Although, in behavioral group, after 3 months of BRAT, there was some improvement as regard presence of fluid and semisolid residue in both pyriform fossa and vallecula and presence of solid residue in vallecula but no improvement of solid residue in pyriform fossa. But there was nearly no change at all, in injection group, regarding presence of residue in both pyriform fossa and vallecula between before, 1w and 3m after intervention so p value there was no significance. The 8-point Penetration-Aspiration scale (PAS) showed a significant improvement between both groups 1 week and 3 months after intervention for fluids for injection group but no significant difference between them regarding PAS for semisolids or solids. In BRAT, although there was some improvement in PAS for fluids and semisolids between before and 3 months after, but it did not reach the significance. Regarding food consistency affected, chocking of fluid significantly improved in both groups. But there was no significance regarding chocking of semisolids and solids in both groups. Also, there was no significant difference regarding presence of swallowing difficulty of different food consistencies in both groups; however, there was some improvement in swallowing difficulty of different consistencies in behavioral group. Injection laryngoplasty (IL) and Behavioral Readjustment therapy (BRAT) can improve oropharyngeal dysphagia in patients with unilateral vocal fold paralysis. Each acts in a different way and on different parameters of swallowing so it is of a great value to combine both interventions in the management to get benefit from both for best results.