Factors Directing Treatment Decision-Making in the Management of Glottic Insufficiency.

Objectives: To examine factors that direct decisions in the treatment of glottic insufficiency and propose a paradigm that may assist in treatment decision-making in glottic insufficiency.

Methods: A retrospective chart review was completed of 73 patients with vocal fold atrophy, presbyphonia, or vocal fold motion impairment, including diagnosis, Voice Handicap Index-10 (VHI-10), Voice Problem Impact Scales (VPIS), Glottal Function Index (GFI), Eating Assessment Tool-10 (EAT-10), Consensus Auditory Perceptual Analysis of Voice (CAPE-V), glottal gap size, stimulability, treatment decisions, and outcomes. Univariate and multivariate logistic regression analyses were performed to identify which variables predicted initial treatment recommendation. Mann-Whitney U analysis and Wilcoxon signed-rank tests were used to analyze outcomes.

Results: Stimulability (Wald = 27.593; p < 0.001), diagnosis (Wald = 26.496; p < 0.001), CAPE-V score (Wald = 14.875; p < 0.001), glottal gap size (Wald = 12.045; p < 0.001), and VHI-10 score (Wald = 10.384; p = 0.001) were the significant predictors of treatment decision. A decision-making paradigm with these significant variables is proposed, based on the multivariate logistic regression. Utilizing this paradigm, most patients reported improvement from their first-line treatment (86%, n = 51/59) and some reported symptom resolution (24%, n = 14/59). Patients who completed first-line treatment demonstrated significant improvement in VHI-10, GFI, and VPIS scores.

Conclusion: This study provides preliminary insights into factors that impact treatment decision-making in the management of glottic insufficiency. The proposed paradigm based on these factors yielded preliminary positive outcomes. Future investigations will continue to work toward an effective, standardized decision-making model in the management of glottal insufficiency.