Skip to main content Accessibility help

Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis

  • M B Asik (a1), O Karasimav (a2), H Birkent (a1), A L Merati (a3), M Gerek (a1) and Y Yildiz (a2)...



Carbon dioxide laser posterior transverse cordotomy is a common option for bilateral vocal fold paralysis. This study prospectively evaluated aerodynamic and acoustic effects of unilateral carbon dioxide laser posterior transverse cordotomy in bilateral vocal fold paralysis patients.


The study comprised 11 bilateral vocal fold paralysis patients (9 females, 2 males), with a mean age of 46.6 ± 14.1 years. All patients were treated by laser posterior transverse cordotomy. Pre-operative and two-month post-operative assessments were conducted, including: dyspnoea scales, maximum phonation time measurement, spirometry and bicycle ergometry.


All subjective and objective aerodynamic parameters showed statistically significant improvements between the pre- and post-operative period. Objective spirometric and ergometric parameters showed a significant increase post-operatively. The changes in objective voice parameters (fundamental frequency (f0), jitter, shimmer, soft phonation index and noise-to-harmonic ratio) were statistically non-significant; however, there was a significant improvement in subjective voice parameters post-operatively, as assessed by the voice handicap index and grade-roughness-breathiness-asthenia-strain scale (p = 0.026 and p = 0.018 respectively).


Unilateral carbon dioxide laser posterior transverse cordotomy is an effective procedure that results in improved dyspnoea and aerodynamic performance with some worsening of voice parameters.


Corresponding author

Address for correspondence: Dr M Burak Asik, Gulhane Askeri Tip Akademisi, KBB AD, 06018 Etlik, Ankara, Turkey E-mail:


Hide All

Presented orally at the Fall Voice Conference, 23–25 October 2014, San Antonio, Texas, USA.



Hide All
1Segas, J, Stavroulakis, P, Manolopoulos, L, Yiotakis, J, Adamopoulos, G.Management of bilateral vocal fold paralysis: experience at the University of Athens. Otolaryngol Head Neck Surg 2001;124:6871
2Dursun, G, Gokcan, MK.Aerodynamic, acoustic and functional results of posterior transverse laser cordotomy for bilateral abductor vocal fold paralysis. J Laryngol Otol 2006;120:282–8
3Loughran, S, Alves, C, MacGregor, FB.Current aetiology of unilateral vocal fold paralysis in a teaching hospital in the West of Scotland. J Laryngol Otol 2002;116:907–10
4Rosenthal, LH, Benninger, MS, Deeb, RH.Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 2007;117:1864–70
5Feehery, JM, Pribitkin, EA, Heffelfinger, RN, Lacombe, VG, Lee, D, Lowry, LD et al. The evolving etiology of bilateral vocal fold immobility. J Voice 2003;17:7681
6Dennis, DP, Kashima, H.Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1989;98:930–4
7Gokcan, MK, Kurtulus, DF, Ustuner, E, Ozyurek, E, Kesici, GG, Erdem, SC et al. A computational study on the characteristics of airflow in bilateral abductor vocal fold immobility. Laryngoscope 2010;120:1808–18
8Li, Y, Pearce, EC, Mainthia, R, Athavale, SM, Dang, J, Ashmead, DH et al. Comparison of ventilation and voice outcomes between unilateral laryngeal pacing and unilateral cordotomy for the treatment of bilateral vocal fold paralysis. ORL J Otorhinolaryngol Relat Spec 2013;75:6873
9Sapundzhiev, N, Lichtenberger, G, Eckel, HE, Friedrich, G, Zenev, I, Toohill, RJ et al. Surgery of adult bilateral vocal fold paralysis in adduction: history and trends. Eur Arch Otorhinolaryngol 2008;265:1501–14
10Olthoff, A, Zeiss, D, Laskawi, R, Kruse, E, Steiner, W.Laser microsurgical bilateral posterior cordectomy for the treatment of bilateral vocal fold paralysis. Ann Otol Rhinol Laryngol 2005;114:599604
11Moorthy, R, Balfour, A, Jeannon, JP, Simo, R.Recurrent laryngeal nerve palsy in benign thyroid disease: can surgery make a difference? Eur Arch Otorhinolaryngol 2012;269:983–7
12Jacobson, BH.The voice handicap index (VHI): development and validation. Am J Speech Lang Pathol 1997;6:337–44
13Havas, T, Lowinger, D, Priestley, J.Unilateral vocal fold paralysis: causes, options and outcomes. Aust N Z J Surg 1999;69:509–13
14Mahler, DA, Wells, CK.Evaluation of clinical methods for rating dyspnea. Chest 1988;93:580–6
15Camargo, LA, Pereira, CA.Dyspnea in COPD: beyond the modified Medical Research Council scale. J Bras Pneumol 2010;36:571–8
16Wilmore JH, Costill DL. Physiology of Sport and Exercise, 2nd edn.Champaign, Illinois: Human Kinetics, 1999;516–31
17Hans, S, Vaissiere, J, Crevier-Buchman, L, Laccourreye, O, Brasnu, D.Aerodynamic and acoustic parameters in CO2 laser posterior transverse cordotomy for bilateral vocal fold paralysis. Acta Otolaryngol 2000;120:330–5
18Maurizi, M, Paludetti, G, Galli, J, Cosenza, A, Di Girolamo, S, Ottaviani, F.CO2 laser subtotal arytenoidectomy and posterior true and false cordotomy in the treatment of post-thyroidectomy bilateral laryngeal fixation in adduction. Eur Arch Otorhinolaryngol 1999;256:291–5
19Kashima, HK.Documentation of upper airway obstruction in unilateral vocal cord paralysis: flow-volume loop studies in 43 subjects. Laryngoscope 1984;94:923–37
20Lawson, G, Remacle, M, Hamoir, M, Jamart, J.Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: functional results. J Voice 1996;10:314–19


Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis

  • M B Asik (a1), O Karasimav (a2), H Birkent (a1), A L Merati (a3), M Gerek (a1) and Y Yildiz (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed