Judgment of voice improvement after recurrent laryngeal nerve section for spastic dysphonia: Clinicians versus patients

Four or more years after recurrent laryngeal nerve section for adductor spastic dysphonia, 25 patients assessed their voice quality and phonatory effort in relation to presurgical status, using categorical ratings (gradations of better or worse, and of easier and harder) and also numerical ratings. Quality was judged better by 88%, and effort easier by 84%; but many thought the improvement was only moderate or slight. Three speech pathologists, assessing presurgical and current recordings of the patients' voices numerically, rated the majority of the better and easier voices much closer to their presurgical status than to normal. Clinicians were highly consistent and reliable in their assessments. Patients were often in disagreement with clinician ratings and generally rated their dysphonia as less severe than the clinicans did. These discrepancies are discussed within the context of contradictory opinions regarding the efficacy of recurrent laryngeal nerve section for the treatment of adductor spastic dysphonia.