Temporal muscle and fascia transplantation for unilateral vocal fold paralysis: short- and medium-term results in a case series

Temporal muscle and fascia transplantation for unilateral vocal fold paralysis: short- and medium-term results in a case series | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 23 April 2025 V1 Latest version Share on Temporal muscle and fascia transplantation for unilateral vocal fold paralysis: short- and medium-term results in a case series Authors : Wenting Deng , Jiawang Tian , Haifeng Liang , Faya Liang 0000-0002-9515-9238 , Wenting Liang , Shibei Zheng , Jinshan Yang , Zhong Guan 0000-0003-1965-1279 , and Qian Cai [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174539014.40379229/v1 224 views 103 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: This study investigates the use of autologous temporal muscle and fascia transplantation for the treatment of unilateral vocal fold paralysis (UVFP). Objectives: To assess the efficacy of autologous temporal muscle and fascia transplantation in treating glottic insufficiency resulting from UVFP and to evaluate its impact on treatment outcomes and prognosis. Methods: Twenty-three patients with UVFP underwent autologous temporal muscle and fascia transplantation. Preoperative and postoperative assessments were performed using dynamic laryngoscopy, vocal acoustics, and aerodynamic measurements. Results: Phonation showed improvement in all 23 patients one month after surgery, with significant enhancement observed by three months postoperatively. At six months, voice quality stabilized, with both subjective and objective measures of voice acoustics and aerodynamic parameters showing marked improvements compared to preoperative values. Notably, vocal fold structure and mucosal vibration approached normal, and glottic closure improved significantly. The subjective assessments of hoarseness, including grade, roughness, breathiness, asthenia, and strain (GRBAS), as well as Voice Handicap Index (VHI) scores, demonstrated significant improvement (p < 0.05). Additionally, vocal acoustic parameters and maximum phonation time showed significant differences from baseline (p < 0.05). Conclusion: Autologous temporal muscle and fascia transplantation is an effective treatment for UVFP, significantly improving voice quality and glottic function. Introduction Unilateral vocal fold paralysis (UVFP) induced by nerve injury commonly manifests as hoarseness and accidental aspiration, resulting from glottic insufficiency 1,2 . Surgical options for treating UVFP include laryngeal framework surgery, vocal fold injection augmentation, and recurrent laryngeal nerve repair 3 . Vocal fold medialization or augmentation can alleviate glottic insufficiency and reduce air leakage. Provided the vocal fold mucosa remains intact, these interventions can also enhance glottal closure. Vocal fold injection augmentation, characterized by minimal trauma and simplicity of operation, is widely used to address glottic insufficiency. Typically, autologous tissues or allogeneic biomaterials are injected into the paraglottic space to promote vocal fold medialization and improve glottic closure. Common injectable materials include autologous substances (such as fat and fascia) and allogeneic materials (such as calcium hydroxyapatite, hyaluronic acid, and collagen-based products) 4-7 . However, the use of allogeneic materials carries certain risks, including delayed systemic hypersensitivity reactions and the potential for vocal fold stiffness due to fibrosis 8-9 . In contrast, autologous materials are immune-compatible and easy to harvest, but the injection process often requires artificial processing of the materials. For instance, the fat injection technique, involving centrifugation, causes significant lipocyte destruction, leading to faster resorption and less durable grafts 10 . Furthermore, the processing of autologous fascia for injection may reduce its physiological viability, and there is a tendency for the injected material to disperse over time 11 . As a result, the absorption rate and compensatory response can vary among individuals. Some patients may require a second injection procedure to achieve satisfactory voice outcomes 12 . Tsunoda et al. 13 proposed autologous fascia transplantation into the vocal fold (ATFV) for treating sulcus vocalis and vocal fold scarring, reporting satisfactory clinical outcomes. Compared to autologous fat, which is commonly used as a filler, autologous fascia is more resistant to absorption. Strengthening the vocal folds with autologous fascia has been shown to improve voice quality with more stable long-term results. Michael 14 and Pinto 15 reported promising outcomes using ATFV for repairing vocal fold closure insufficiency. Building on this, we applied and further refined this technique to repair UVFP resulting from nerve injury. To ensure adequate volume and resistance to resorption, we combined the temporalis muscle with fascia. This study assessed the voice quality of patients preoperatively and at 1, 3, 6, and 12 months postoperatively, using both subjective and objective indices of laryngeal function, voice quality, and voice disorders. Our findings indicate that autologous temporalis muscle and fascia grafting is an effective treatment for UVFP with vocal fold closure insufficiency, yielding satisfactory results. Materials and Methods Case Selection This study included 23 patients diagnosed with UVFP, admitted to the Department of Otorhinolaryngology-Head and Neck Surgery between January 2019 and December 2024. The cohort consisted of 16 males and 7 females, aged 20 to 66 years, with disease durations ranging from 9 to 50 months. These patients were referred from other hospitals or departments within our institution and had previously undergone voice therapy with limited success. In terms of etiology, 16 patients had undergone thyroid surgery, 5 had received surgery for parapharyngeal space schwannomas, and 2 patients had undergone thoracic endovascular aortic repair (TEVAR). Clinically, patients presented with hoarseness, difficulty swallowing (particularly when drinking), and vocal fatigue. Dynamic laryngoscopy revealed that the affected vocal fold was positioned paramedian, with a loose and arcuate appearance, and a spindle-shaped glottic insufficiency was observed during phonation. Surgical Procedure All patients underwent general anesthesia and received transplantation of the temporal muscle and fascia under suspension microlaryngoscopy. Preparation of the Temporal Muscle and Fascia A transverse incision, approximately 2 cm in length, was made along the hairline above the anterior auricle. Layer-by-layer dissection was performed to reach the temporal fascial layer. The fascia was then incised to expose the underlying temporal muscle. A sample of the temporal muscle and fascia (1.5 × 0.6 × 0.3 cm³) was harvested and divided into small tissue blocks (2-3 mm³) for subsequent use (Fig 1). Preparation of the Vocal Fold Pocket A suspension laryngoscope was inserted to visualize the glottic region. A longitudinal incision, approximately 3-4 mm from the edge of the vocal fold, was made using a laser (2-2.5W, Super Pulse Mode). The excision, approximately 8-12 mm in length (roughly 2/3 of the entire vocal fold), and 4-5 mm in depth, extended through the vocal ligament and vocalis muscle to create a pocket (Fig 2A). Vocal Fold Augmentation with Temporal Muscle and Fascia Tissues The prepared muscle and fascia tissues were used to fill the vocal fold pocket (Fig 2B). The volume of the tissue was adjusted to ensure that the free edge of the vocal fold bulged evenly inward. The incision in the vocal fold was then sutured using 3-4 stitches with a 7-0 suture to prevent any extrusion of muscle and fascia tissue (Fig 2C). Postoperative Management Patients were instructed to avoid vocalization for the first week postoperatively. Gradual increases in speaking time were allowed, with normal speaking functions typically restored within two weeks. Inhalation therapy was administered for 3-5 days, and patients received antibiotics and corticosteroids for a duration of three days. Postoperative Follow-Up and Voice Assessment Dynamic Laryngoscopy Twenty-three patients underwent dynamic laryngoscopy one week before the operation and at 1, 3, 6, and 12 months postoperatively to assess the recovery of the surgical site. (Fig 3) Subjective Voice Assessment The Voice Handicap Index-10 (VHI-10) was used for self-assessment (score range: 0-40 points). Total hoarseness was evaluated by two experienced voice physicians using the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale, where: grade 0 indicates normal, grade 1 indicates mild abnormality, grade 2 indicates moderate abnormality, and grade 3 indicates severe abnormality. The mean score from both physicians was calculated for each patient. Objective Voice Assessment Voice Acoustic Assessment: The multidimensional voice program (MDVP) system was utilized to assess voice characteristics. A microphone was positioned 15 cm from the patient’s lips. Phonation was sustained for 5 seconds per trial, with 2 seconds of stable audio collected for analysis of jitter and shimmer levels. Voice assessments were conducted preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. Maximum Phonation Time (MPT) Test: The Phonatory Aerodynamic System (PAS, Kay Pentax, USA) was used to assess MPT. Patients were instructed to take a deep breath, then secure a mask over the mouth and nose to prevent air leakage. They were asked to phonate the vowel “a” for as long as possible in a comfortable manner, and this was repeated three times. The system automatically recorded the MPT, and the longest value was used for analysis. Statistical Methods Statistical analysis was performed using SPSS 25.0 software. Data are presented as mean ± standard deviation (χ ± s). One-way repeated-measures analysis of variance and paired t-tests were used to compare voice parameters before and after the operation. A p-value of Dynamic Laryngoscopy Regular postoperative laryngoscopy was performed to monitor the recovery of the laryngeal wound. The wound was dry, clean, and exhibited a pale red appearance, with slight edema observed in the mucosa near the incision margin. In two patients, re-examination at one month postoperatively revealed a small amount of granulation tissue at the incision site, which resolved spontaneously within 3 to 6 months. Subjective Voice Assessment A significant improvement in hoarseness (as measured by GRBAS and VHI scores) was observed at three months postoperatively compared to preoperative levels, with the difference being statistically significant (p < 0.05) (Table 1, Fig. 4). Twelve patients showed marked improvement in voice quality, with the vocal fold mucosal vibration on the surgical side approaching normal, and the glottis exhibiting near-complete closure. The total score increased by two grades in twelve patients and by one grade in eight patients. Objective Voice Assessment Significant changes in vocal acoustic parameters (jitter and shimmer) and maximum phonation time (MPT) were observed postoperatively compared to preoperative values (p < 0.05) (Table 2). In fifteen patients (65.22%), acoustic parameters reached the normal range, and seventeen patients (73.91%) showed normal MPT. Three months after surgery, vocal fold morphology gradually returned to normal, and phonation progressively improved. By six months postoperatively, voice quality stabilized, and both subjective and objective assessments of acoustic and aerodynamic parameters demonstrated significant improvement compared to preoperative values. No statistically significant differences were found between 6 and 12 months postoperatively (Fig. 5). All twenty-three patients were followed for more than one year. The most significant improvement in voice quality occurred within the first three months after surgery. Mild deterioration in voice quality was observed in some patients between 3 and 6 months postoperatively, with stabilization of voice quality thereafter. Fifteen patients were followed for up to two years, with favorable stability of phonation noted over time. Discussion The patients in this study all presented with UVFP due to nerve injury. The resulting atrophy of the vocal fold muscles, coupled with the absence of innervation, caused the vocal fold to adopt an arcuate shape, leading to glottic insufficiency during phonation. The results of this study indicate that autologous temporal muscle and fascia transplantation can effectively augment the vocal fold volume and displace the free edge of the vocal fold inward. This approach facilitates better closure of the vocal folds during phonation, improving vocal function in patients with UVFP caused by glottic insufficiency. Long-term follow-up for more than one year demonstrated stable efficacy of the temporal muscle and fascia transplant, as evidenced by consistent improvements in VHI and GRBAS scores, acoustic parameters, and stroboscopic laryngoscopy findings. The use of autologous temporal muscle and fascia transplantation is a minimally invasive procedure that induces minimal inflammatory response 16 . No significant complications were observed, with the exception of localized granulation tissue in a few cases. Literature reports have highlighted failures in vocal fold augmentation with fascia, typically due to factors such as mucosal damage to the vocal fold groove, improper material selection, or loss of fascia due to postoperative issues such as severe coughing or local infection 13 . However, no such surgical failures or adverse reactions occurred in our study. While granulation tissue appeared in two cases one month after surgery, it resolved spontaneously within 3 to 6 months. Autologous fascia lacks antigenic fibrous structures, making it well-suited for survival, and is characterized by excellent resistance to absorption and a low metabolic rate. It has been extensively utilized in tympanoplasty and plastic reconstructive surgery, yielding favorable outcomes 17 . Temporal muscle is commonly employed in craniofacial surgery 18,19 and has been shown to repair skull base defects, such as cerebrospinal fluid rhinorrhea 20 , with both functional and cosmetic benefits. Furthermore, temporal muscle tissue increases the volume of the vocal fold. Its greater plasticity and filling capacity ensure that the vocal fold pocket is adequately filled with muscle tissue in all positions, thereby facilitating optimal adjustment of the vocal fold shape and promoting a uniform inward bulging of the glottal free edge. While previous studies have largely focused on the use of fat, fascia, or a combination of both for vocal fold injections, to our knowledge, muscle transplantation has not been reported 21-23 . The long-term efficacy of fat injections remains inconsistent in the literature 24,25 , and the use of large fat or fascia particles for vocal fold injection presents significant challenges. In contrast, the technique used in this study involved opening the vocal fold and filling it with a mixture of temporal muscle and fascia. This approach proved to be technically straightforward, provided better visualization, and allowed for more uniform and complete filling of the vocal fold. Compared to paraglottic space augmentation, this transplantation material was placed closer to the free edge of the vocal fold, enhancing its plasticity while minimizing the required tissue volume. However, scarring resulting from invasive surgery is thought to cause lateral retraction of the vocal folds, potentially affecting articulation. While it is true that vocal cord incision may lead to scarring that could influence pronunciation, we employed a careful incision design. Specifically, we made the incision 3 to 4 mm from the free edge of the vocal fold to preserve its plasticity and mitigate the impact of scarring on the free edge’s vibratory function. All patients in this study were followed for more than one year, a sufficient period for scar formation. Acoustic assessments demonstrated that the mixture of temporal muscle and fascia transplantation significantly improved both subjective and objective vocal parameters in these patients. Fascia consists of collagen fibers and the fibroblast-rich intercellular matrix, with thicker fascia offering greater resistance to resorption than thinner fascia. In 1998, Rihkanen 26 first reported the use of autologous fascia lata for vocal fold augmentation in 11 patients with UVFP. In 1999, Tsunoda 13 et al. highlighted that autologous fascia augmentation could effectively treat vocal fold grooves, given the fascia’s similarity to the lamina propria of the vocal fold, which facilitates the restoration of vocal fold vibration. In 2005, Tsunoda 8 examined patients who received temporal muscle tamponade of the vocal fold groove, with follow-up periods ranging from six months to three years. The results indicated improvements in voice quality, glottal closure, and vocal fold vibration, as well as stability over time. Autologous temporal fascia implants appear to address glottal closure and vocal fold vibration issues for at least one year 27 . In the present study, the use of temporal muscle and fascia for vocal fold transplantation resulted in significant improvements in phonation for patients with nerve injury-induced UVFP. Although the effect fluctuated during the first 3–6 months postoperatively, the overall outcome remained stable and favorable. Postoperative assessments revealed notable reductions in GRBAS and VHI-10 scores, with the most significant improvement observed at three months. Although some decline was noted at six months, the results gradually stabilized thereafter. One year following the augmentation with the temporal muscle and fascia mixture, patients continued to exhibit relatively stable voice quality, favorable glottal closure, and stable objective parameters of jitter, shimmer, and MPT. Conclusion Transplantation of temporal muscle and fascia offers an effective treatment for nerve injury-induced UVFP, resulting in relatively stable voice quality postoperatively. A typical case of paralysis of the left vocal fold: A 43-year-old patient with a two-year history of hoarseness following resection of a left parapharyngeal mass. After six months of voice training, there was no significant improvement in hoarseness. Following the surgical intervention, the patient experienced substantial improvement in voice quality, and a one-year outpatient follow-up revealed near-normal vocal function. At the two-year follow-up, the patient’s voice remained stable and functional (Video 1-6). References 1.Vinson KN, Zraick RI, Ragland FJ. Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis: follow‑up at six months. Laryngoscope.2010;120:1802‑1807.doi: 10.1002/lary.20982 2.Mortensen M, Carroll L, Woo P. Arytenoid adduction with medialization laryngoplasty versus injection or medialization laryngoplasty: the role of the arytenoidopexy. Laryngoscope. 2009;119:827‑831. doi: 10.1002/lary.20171. 3. Hu H, Hung Y, Lin S, etal. Office-Based Autologous Fat Injection Laryngoplasty for Glottic Insufficiency in Patients Under 50 Years Old. Journal of Voice. 2019;33:747-750. doi:10.1016/j.jvoice.2018.03.012 4. Alam M, Gladstone H, Kramer EM, et al. Guidelines of care: injectable fillers. Dermatol Surg. 2008;34:S115-S148.doi:10.1111/j.1524-4725.2008.34253.x 5. Nishio N, Fujimoto Y, Hiramatsu M, et al. Computed tomographic assessment of autologous fat injection augmentation for vocal fold paralysis. Laryngoscope Investigative Otolaryngology. 2017;2:459-465.doi:10.1002/lio2.125 6. Lahav Y, Malka-Yosef L, Shapira-Galitz Y, et al. Vocal Fold Fat Augmentation for Atrophy, Scarring, and Unilateral Paralysis: Long-term Functional Outcomes. Otolaryngology–Head and Neck Surgery. 2021; 164:631-638. doi: 10.1177/0194599820947000 7. Zeleník K, Formánek M, Walderová R, et al. Five-year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite. Eur Arch Otorhinolaryngol. 2021; 278 :1139-1144. doi:10.1007/s00405-020-06479-6 8. Koichi Tsunoda, Kenji Kondou, Kimitaka Kaga, et al. Autologous transplantation of fascia into the vocal fold: long-term result of type-1 transplantation and the future. Laryngoscope . 2005 Dec;115(12 Pt 2 Suppl 108):1-10. doi: 10.1097/01.mlg.0000183966.72921.31 9. M Nakayama, C N Ford, D M Bless. Teflon vocal fold augmentation: failures and management in 28 cases. Otolaryngol Head Neck Surg . 1993 Sep;109(3 Pt 1):493-8. doi: 10.1177/019459989310900318 10. Timothy M McCulloch, Brian T Andrews, Henry T Hoffman, et al. Long-term follow-up of fat injection laryngoplasty for unilateral vocal cord paralysis. Laryngoscope . 2002 Jul;112(7 Pt 1):1235-8. doi: 10.1097/00005537-200207000-00017 11. K Tsunoda, T Baer, S Niimi. Autologous transplantation of fascia into the vocal fold: long-term results of a new phonosurgical technique for glottal incompetence. Laryngoscope . 2001 Mar;111(3):453-7. doi: 10.1097/00005537-200103000-00014. 12. Choi N, Won S, Jin H,etal. Additional Injection Laryngoplasty for Patients With Unilateral Vocal Fold Paralysis. Laryngoscope. 2020 Dec;130(12):2863-2868. doi:10.1002/lary.28567. 13. K Tsunoda, M Takanosawa, S Niimi. Autologous transplantation of fascia into the vocal fold: a new phonosurgical technique for glottal incompetence. Laryngoscope . 1999 Mar;109(3):504-8. doi: 10.1097/00005537-199903000-00030. 14. Michael J Pitman, Shaina M Rubino, Amy L Cooper. Temporalis fascia transplant for vocal fold scar and sulcus vocalis. Laryngoscope . 2014 Jul;124(7):1653-8. doi: 10.1002/lary.24536. Epub 2014 Jan 15. 15. José Antônio Pinto, Mario Luiz Augustus da Silva Freitas, Arturo Frick Carpes, et al. Autologous grafts for treatment of vocal sulcus and atrophy. Otolaryngol Head Neck Surg . 2007 Nov;137(5):785-91. doi: 10.1016/j.otohns.2007.05.059. 16. Tsunoda K, Niimi S. Autologous transplantation of fascia into the vocal fold．Laryngoscope. 2000;110:680-682.doi:10.1097/00005537-200004000-00026 17. Cueva RA, Areolar temporalis fascia: a reliable graft for tympanoplasty. Am J Otol.1999:20(6):709-711. 18. Clauser L,Curioni C, Spanio S. The use of the temporalis muscle flap in facial and craniofacial reconstructive surgery. A review of 182 cases. J Cranio Maxill Surg. 1995;23(4):203-214.doi:10.1016/s1010-5182(05)80209-4 19. Lam D, Carlson ER. The temporalis muscle flap and temporoparietal fascial flap. Oral Maxil Surg Clin. 2014;26(3):359-369.doi:10.1016/j.coms.2014.05.004 20. Chi JH, Sughrue M, Kunwar S. The ”yo-yo” technique to prevent cerebrospinal fluid rhinorrhea after anterior clinoidectomy for proximal internal carotid artery aneurysms. Neurosurgery. 2006;59(1 Suppl 1):101-107.doi: 10.1227/01.NEU.0000219962.15984.34 21. Sato K, Umeno H, Nakashima T. Autologous fat injection laryngohypopharyngoplasty for aspiration after vocal fold paralysis. Ann Otol Rhinol Laryngol.2004, 113:87⁃92.doi:10.1177/000348940411300201 22. Hsiung MW, Kang BH, Pai L, Su WF, et al. Combination of fascia transplantation and fat injection into the vocal fold for sulcus vocalis: long-term results. Ann Otol Rhinol Laryngol. 2004;113:359-366.doi:10.1177/000348940411300504 23. Karle WE, Helman SH; Cooper A; et al. Temporalis Fascia Transplantation for Sulcus Vocalis and Vocal Fold Scar: Long-Term outcomes. Ann Otol Rhinol Laryngol.2018;127:223-228. doi:10.1177/0003489417753224 24. Brandenburg JH, Kirkham W, Koschkee D. Vocal cord augmentation with autologous fat. Laryngoscope. 1992;102:495-500. 25. Kruschewsky Lde S, de Mello-Filho FV, dos Santos AC, et al. Autologous fat graft absorption in unilateral paralyzed canine vocal folds. Laryngoscope. 2007;117:96-100.doi:10.1097/01.mlg.0000245013.98844.30 26. Rihkanen H. Vocal fold augmentation by injection of autologous fascia. Laryngoscope.1998, 108: 51⁃54.doi:10.1097/00005537-199801000-00010 27. Pitman MJ, Rubino SM, Cooper AL. Temporalis fascia transplant for vocal fold scar and sulcus vocalis. Laryngoscope. 2014;124:1653-1658.doi:10.1002/lary.24536 Figure captions Fig 1 . Preparation of autologous temporal muscle and fascia. Fig 2 . A. Preparation of the vocal fold pocket. B. Autologous temporal muscle and fascia transplantation. C. Sutured with 7-0 suture. Fig 3 . Left vocal fold paralysis, before and after unilateral autologous temporal muscle and fascia transplantation. A. Preoperative abduction. Note left vocal fold concavity. B. Preoperative adduction with incomplete glottal gap. C. One-month postoperative abduction. D. One-month postoperative adduction. E . Three-month postoperative abduction. F . Three-month postoperative adduction. G. Two-year postoperative abduction. H . Two-year postoperative adduction. Fig 4. Comparison of VHI-10 Grade before and after surgery. * : paired t -test indicates that the difference between one postoperative time point and the preoperative time point is statistically significant ( * : p 0.05). Fig 5. Comparison of Jitter、shimmer and MPT before and after surgery. * : paired t -test indicates that the difference between one postoperative time point and the preoperative time point is statistically significant ( * : p 0.05). Video captions Video 1. Patient pronunciation preoperative. Video 2. Patient vocal cord activity preoperative adduction and abduction. Video 3. Patient pronunciation one-month postoperative. Video 4. Patient vocal cord activity one-month postoperative adduction and abduction. Video 5. Patient pronunciation two-year postoperative. Video 6. Patient vocal cord activity two-year postoperative adduction and abduction. Table 1. Preoperation and postoperation subjective vocal perception assessment (VHI-10 and GRBAS). Preoperation 28.35±6.50 2.70±0.70 2.52±0.67 2.09±0.95 1.70±0.76 1.04±0.37 1 month after operation 20.96±6.69 1.48±0.59 1.48±0.67 1.09±0.51 0.91±0.42 0.96±0.47 3 months after operation 13.65±3.07 1.39±0.58 0.70±0.76 0.61±0.50 0.39±0.50 0.48±0.51 6 months after operation 14.91±3.65 1.26±0.62 0.61±0.50 0.52±0.51 0.57±0.51 0.65±0.78 12 months after operation 13.65±3.38 0.91±0.60 0.78±0.67 0.52±0.51 0.43±0.51 0.48±0.59 χ: mean value, s:standard deviation. Table 2. Preoperation and postoperation objective acoustic parameters assessment. Preoperation 5.13±1.58 9.81±3.82 5.56±1.08 1 month after operation 2.95±0.85 6.40±0.82 9.31±2.47 3 months after operation 1.55±0.27 3.62±1.06 13.97±2.48 6 months after operation 1.50±0.26 3.88±1.06 13.83±2.48 12 months after operation 1.44±0.26 3.71±1.07 13.94±2.49 χ: mean value, s:standard deviation. 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Authors Affiliations Wenting Deng Sun Yat-Sen Memorial Hospital View all articles by this author Jiawang Tian Sun Yat-Sen Memorial Hospital View all articles by this author Haifeng Liang Sun Yat-Sen Memorial Hospital View all articles by this author Faya Liang 0000-0002-9515-9238 Sun Yat-Sen Memorial Hospital View all articles by this author Wenting Liang Sun Yat-Sen Memorial Hospital View all articles by this author Shibei Zheng Sun Yat-Sen Memorial Hospital View all articles by this author Jinshan Yang Sun Yat-Sen Memorial Hospital View all articles by this author Zhong Guan 0000-0003-1965-1279 Sun Yat-Sen Memorial Hospital View all articles by this author Qian Cai [email protected] Sun Yat-Sen Memorial Hospital View all articles by this author Metrics & Citations Metrics Article Usage 224 views 103 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Wenting Deng, Jiawang Tian, Haifeng Liang, et al. 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