COMPLICATIONS OF PHONOSURGERY - RESULTS OF A NATIONAL SURVEY

Objective: Medialization laryngoplasty (ML) and arytenoid adduction (A A) have become common treatments of vocal fold paralysis. The widespre ad use of these procedures has required many surgeons to learn these n ew surgeries through postgraduate education sources. Little is known r egarding the efficacy of the learning methods and the types and incide nce of complications in a large number of surgeons' experience. Method s: A survey consisting of 23 questions regarding complications of ML a nd AA was sent to 7364 otolaryngologists. Results: A 33% response rate resulted in 2436 returned surveys of which 43% stated they performed ML and/or AA (n = 1039). The survey represents 14,621 cases of ML. The average respondent performed 12 ML in the past 5 years. Forty-two per cent of the respondents reported experience with one or more major com plication. Airway complications requiring intervention occurred more f requently following AA than ML. The most common major complications we re implant migration and failure to improve voice quality. The ML revi sion rate was 5.4% and the reported voice quality following revision w as positive in 90% of cases. A statistically significant difference in major ML complication rate was found between surgeons with experience doing fewer than 10 MLs and those with experience doing more than 10 MLs. Similar findings showed that a higher major complication rate occ urred for surgeons performing fewer than two MLs per year compared wit h counterparts who average two or more MLs per year. A near 1% implant extrusion rate was found. Most of the extrusions occurred into the ai rway. Conclusions: This is a study of the use and complications of ML/ AA based on more than 14,000 procedures. Wide-spread use of ML for voc al fold paralysis was found. A notable rate of poor voice quality foll owing ML/AA was identified and led to a 5.5% revision rate for ML. Rev ision ML resulted in an improved voice quality in more than 90% of the reported cases. There appears to be a ''learning curve'' for performi ng ML as well as an increased complication rate for those surgeons who perform fewer than two MLs per year and have a total career experienc e of fewer than 10 procedures. These findings suggest that ML may resu lt in increased complications if the surgeon is not experienced or doe s not perform the surgery regularly.