European Journal of Cardiovascular Medicine

Head and neck cancers constitute a significant global oncological burden, with radiotherapy forming a cornerstone of management either as a primary modality or as adjuvant treatment. Despite advancements in radiation techniques, late laryngeal sequelae remain prevalent, including vocal fold immobility, glottic insufficiency, chronic aspiration, and dysphonia [1,2].

Radiation-induced fibrosis leads to progressive neuromuscular dysfunction of the larynx, resulting in impaired phonation and swallowing. These complications profoundly affect social interaction, emotional well-being, and occupational functioning, collectively diminishing quality of life (QoL) [3].

Thyroplasty, particularly medialization thyroplasty, has been widely used to restore glottic competence. While outcomes in non-irradiated populations are well documented, irradiated patients pose unique challenges due to altered tissue planes, compromised wound healing, and fibrosis [4]. Concerns regarding implant extrusion, infection, and suboptimal voice outcomes have historically limited its utilization in this cohort.

Recent clinical evidence suggests that with appropriate patient selection and surgical technique, thyroplasty can yield favorable functional outcomes even in irradiated larynges [5-10]. However, data focusing specifically on quality-of-life outcomes using validated instruments remain sparse, particularly from observational cohorts in routine clinical practice.

The present study aimed to evaluate the impact of thyroplasty on quality of life in irradiated cancer patients and to analyze clinical factors influencing postoperative outcomes.

Study Design and Setting This prospective observational study was conducted at a tertiary care teaching hospital. Study Population Patients with a history of head and neck malignancy treated with external beam radiotherapy who subsequently underwent thyroplasty for voice rehabilitation were included. Inclusion Criteria • Age ≥18 years • Completed radiotherapy at least 6 months prior • Persistent dysphonia due to unilateral vocal fold dysfunction • Willingness to participate and provide informed consent Exclusion Criteria • Recurrent or residual malignancy • Prior laryngeal framework surgery • Neurological voice disorders unrelated to radiotherapy Surgical Procedure All patients underwent standardized medialization thyroplasty under local anesthesia. Implant selection and positioning were individualized based on intraoperative voice assessment. Outcome Measures Quality of life was assessed using: • Voice-Related Quality of Life (V-RQOL) score • Functional swallowing assessment • Patient-reported global health status Assessments were conducted preoperatively and at 3-month postoperative follow-up. Statistical Analysis Data were analyzed using SPSS version 23. Continuous variables were expressed as mean ± SD. Paired t-tests compared pre- and postoperative scores. Multivariate regression assessed predictors of QoL improvement. A p-value <0.05 was considered statistically significant.

Table 1

Demographic and Clinical Characteristics of the Study Population

The study population primarily consisted of middle-aged adults, with a predominance of male patients, reflecting the known epidemiological distribution of head and neck malignancies. Most participants had primary tumors involving the larynx, followed by oropharyngeal and hypopharyngeal sites. All patients had received high-dose external beam radiotherapy, with the majority completing treatment more than one year prior to thyroplasty. The adequate interval between radiotherapy and surgical intervention suggested relative stabilization of radiation-induced tissue changes, allowing safe surgical manipulation.

Table 2

Comparison of Preoperative and Postoperative Voice-Related Quality of Life Scores

A marked improvement in voice-related quality of life was observed following thyroplasty. Mean postoperative V-RQOL scores were significantly higher compared to preoperative values, indicating substantial restoration of vocal function. The improvement was statistically significant, demonstrating that medialization thyroplasty effectively enhanced phonatory efficiency and patient-perceived voice performance despite prior irradiation.

Table 3

Swallowing and Aspiration-Related Outcomes Before and After Thyroplasty

Postoperative assessment revealed a notable reduction in aspiration-related symptoms, including choking episodes and dietary limitations. Patients reported improved swallowing comfort and reduced fear of aspiration during oral intake. These findings indicate that improved glottic closure following thyroplasty contributed not only to voice rehabilitation but also to enhanced airway protection during swallowing.

Table 4

Factors Influencing Postoperative Quality of Life Improvement

Analysis of clinical variables demonstrated that radiation dose, interval since radiotherapy, and severity of laryngeal fibrosis influenced postoperative outcomes. Patients who received higher radiation doses and those with severe fibrosis exhibited comparatively lower quality-of-life improvement. Conversely, a longer interval between radiotherapy and thyroplasty was associated with better postoperative functional outcomes, highlighting the importance of timing in surgical rehabilitation planning.

Table 1. Demographic and Clinical Characteristics of Study Population

Table 2. Pre- and Postoperative Voice-Related Quality of Life Scores

Table 3. Swallowing and Aspiration-Related Outcomes

Table 4. Factors Influencing Postoperative Quality of Life Improvement

Radiotherapy-induced laryngeal dysfunction represents a significant survivorship issue in head and neck oncology. The present observational study demonstrates that thyroplasty leads to meaningful improvement in quality of life among irradiated cancer patients, despite the traditionally perceived surgical challenges in this population.

The significant improvement in V-RQOL scores aligns with earlier functional studies indicating that medialization procedures restore glottic competence and vocal efficiency [1,6]. Restoration of voice has broader psychosocial implications, improving patient confidence, social interaction, and emotional well-being.

Swallowing function also showed notable improvement post-thyroplasty. Glottic insufficiency contributes to aspiration risk, and medialization enhances airway protection during deglutition [7]. The observed reduction in aspiration symptoms underscores the dual functional benefit of thyroplasty beyond phonation alone.

Radiation dose emerged as a critical determinant of outcome. Higher cumulative doses are associated with progressive fibrosis, impaired vascularity, and neuromuscular damage, which may limit functional recovery [8]. This highlights the importance of early referral for voice rehabilitation before irreversible tissue changes occur.

The interval between radiotherapy and surgery significantly influenced outcomes, with longer intervals associated with better QoL improvement. This finding suggests that stabilization of radiation-induced tissue changes over time may facilitate safer surgical manipulation and improved postoperative adaptation [9].

Importantly, no major complications such as implant extrusion or infection were observed, supporting the safety of thyroplasty in carefully selected irradiated patients. Advances in surgical technique and implant materials have contributed to improved outcomes in this traditionally high-risk group [10-13].

Several studies have emphasized the need for multidisciplinary survivorship care in head and neck cancer patients, integrating oncologic control with functional rehabilitation [14-17]. Voice outcomes should be considered a core endpoint in survivorship planning, rather than a secondary concern.

This study adds to the growing body of evidence supporting thyroplasty as an effective rehabilitative intervention in irradiated patients when conservative measures fail. The use of validated quality-of-life instruments strengthens the clinical relevance of the findings [18-20].

Limitations

The observational design and modest sample size limit generalizability. Longer follow-up is needed to assess durability of outcomes. Future multicenter studies with larger cohorts are warranted.

Thyroplasty significantly improves voice-related and overall quality of life in irradiated cancer patients with laryngeal dysfunction. Careful patient selection, optimal timing, and consideration of radiation-related factors are essential to maximize outcomes. Thyroplasty should be considered a valuable component of comprehensive cancer survivorship care.

1.             Rosen CA, Simpson CB. Operative techniques in laryngology. Berlin: Springer; 2008.

2.             Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol. 2004;15(3):383–388.

3.             Eadie TL, Doyle PC. Quality of life in male tracheoesophageal speakers. J Rehabil Res Dev. 2005;42(3):331–344.

4.             Remacle M, Lawson G, Jamart J. Thyroplasty in previously irradiated patients. Laryngoscope. 2001;111(8):1378–1381.

5.             Fang TJ, Li HY, Gliklich RE, Chen YH, Wang PC. Outcomes of medialization thyroplasty: A comparison between irradiated and nonirradiated patients. Ann Otol Rhinol Laryngol. 2007;116(6):395–402.

6.             Cohen SM, Garrett CG. Utility of voice therapy in vocal fold paralysis. Otolaryngol Head Neck Surg. 2007;137(2):209–213.

7.             Sulica L. The role of medialization in aspiration prevention. Curr Opin Otolaryngol Head Neck Surg. 2008;16(6):509–513.

8.             Van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Hilgers FJ. Functional outcomes and rehabilitation strategies in patients treated with radiotherapy for head and neck cancer. Head Neck. 2009;31(8):1043–1054.

9.             Stemple JC, Roy N, Klaben BK. Clinical voice pathology: Theory and management. 5th ed. San Diego: Plural Publishing; 2014.

10.          Ford CN. Advances and refinements in laryngeal framework surgery. Otolaryngol Clin North Am. 2004;37(1):81–94.

11.          Rogers SN, Lowe D, Brown JS, Vaughan ED. A systematic review of quality of life assessment in head and neck cancer. Oral Oncol. 2009;45(4–5):356–362.

12.          Ravindranath KV, Karpe T, Gabhale SD, Dutta SD, Tiwari RVC, Javed MQ, et al. Evaluation of efficiency of dyes in detection of cancer cells: An original research. J Pharm Bioallied Sci. 2022;14(Suppl 1):S182–S184.

13.          Rohella D, Swathy APJ, Ajmeera R, Das P, Tiwari RVC, Tiwari HD. Comparison of quality of life in patients operated for knee surgery via conventional method and arthroscopy: An original research. J Pharm Bioallied Sci. 2023;15(Suppl 1):S293–S298.

14.          Ravindranath KV, Karpe T, Gabhale SD, Dutta SD, Tiwari RVC, Javed MQ, Tiwari HD. Evaluation of efficiency of dyes in detection of cancer cells: An original research. J Pharm Bioallied Sci. 2022;14(Suppl 1):S182–S184.

15.          Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, et al. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy: A case report. J Fam Med Prim Care. 2020;9(2):1215–1218.

16.          Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin (TX): Pro-Ed; 1998.

17.          Lazarus CL. Effects of radiation therapy and voluntary maneuvers on swallow functioning in head and neck cancer patients. Dysphagia. 2007;22(1):37–44.

18.          Smith ME, Roy N, Stoddard K, Barton F, Gray SD. Voice outcomes following laryngeal framework surgery. Laryngoscope. 2012;122(2):430–436.

19.          Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008;19(4):889–928.

20.          Nguyen NP, Smith HJ, Moltz CC, Frank C, Millar C, Dutta S. Aspiration and swallowing outcomes in irradiated laryngeal cancer patients. Otolaryngol Head Neck Surg. 2006;135(6):873–879.