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

Desi Gutierrez; Jacob R Wright; Matthew R Hoffman; C Blake Simpson; Lauren Timmons Sund; Marina Gurmendi; Edie R Hapner

doi:10.1002/lary.70108

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

Journal article

Peer reviewed

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

Desi Gutierrez, Jacob R Wright, Matthew R Hoffman, C Blake Simpson, Lauren Timmons Sund, Marina Gurmendi and Edie R Hapner

The Laryngoscope, Vol.136(2), pp.898-905

02/2026

DOI: 10.1002/lary.70108

PMID: 40910694

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Abstract

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. 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. 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. 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.

vocal fold paralysis/paresis/motion impairment

speech language pathology

aging voice/presbyphonia

outcomes

Details

Title: Subtitle: Factors Directing Treatment Decision-Making in the Management of Glottic Insufficiency
Creators: Desi Gutierrez - University of California, San Francisco
Jacob R Wright - University of Alabama at Birmingham
Matthew R Hoffman - University of Iowa
C Blake Simpson - University of Alabama at Birmingham
Lauren Timmons Sund - University of Southern California
Marina Gurmendi - University of Alabama at Birmingham
Edie R Hapner - University of Alabama at Birmingham
Resource Type: Journal article
Publication Details: The Laryngoscope, Vol.136(2), pp.898-905
DOI: 10.1002/lary.70108
PMID: 40910694
NLM abbreviation: Laryngoscope
ISSN: 1531-4995
eISSN: 1531-4995
Publisher: Wiley
Language: English
Electronic publication date: 09/05/2025
Date published: 02/2026
Academic Unit: Communication Sciences and Disorders; Stead Family Department of Pediatrics; Otolaryngology
Record Identifier: 9984958606502771

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