الفهرس 
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Abstract
Glottal insufficiency means incomplete glottal closure that is usually caused by unilateral vocal fold palsy, vocal fold atrophy (bowed vocal folds) or scar defect. These conditions are also associated with increased turbulent airflow through inefficient glottis leading to breathy voice. Additionally symptoms of vocal fatigue, shortness of breath frequently co-occur because of increased effort needed to produce voice. The glottic gap does not give adequate airway protection with possible swallowing disorders and aspiration.
Some cases do not require intervention because the main option in the first instance is speech therapy, and in the case of failure, phonosurgery is required. The general goal of surgery is to medialize the affected vocal fold this helps the other healthy vocal fold to achieve the valving contact at midline of the glottis more easily. A wide variety of treatment options have been utilized in improving these problems. It includes vocal fold injection, laryngeal framework surgery (thyroplasty type I with or without arytenoid adduction).
This thesis aims at comparing the injection and medialization laryngoplasty in treatment of large glottic gap regarding the postoperative gap closure and voice improvement.
Thirty patients with adductor vocal cord paralysis study suffered from breathy dysphonia due to glottic gaps 2 mm or more were included in this study. Patients were excluded if they had a successful voice therapy or associated aspiration or if previous phonosurgery was performed.
All included patients were subjected to full clinical history, detailed head and neck examination, Glottic gap measurement, Maximum phonation time MPT and Auditory perceptual assessment APA of voice by a speech and language pathologist using the Modified GRBAS scale especially grade (G) of dysphonia, and breathiness (B) were the most important.
Both surgeries; injection laryngoplasty with CaHA and Gortex medialization laryngoplasty were done under general anesthesia by the same surgical team after at least one year after the paralysis.
Follow up was carried out by the same phoniatrician following the same preoperative evaluation steps and it was repeated and compared at 1st week, 1st month and 6th month after surgery.
Analysis of the results revealed that that the injection laryngoplasty patients showed better improvement in the grade of dysphonia G than group B in the early postoperative period. The thyroplasty group patients gave significantly longer maximum phonation time and smaller gaps than in the injection group.
Both operations could be an effective solution for patients with glottic insufficiency with large gaps. The excellent outcomes persisted for at least 6 months post-treatment. Both treatment modalities for glottic insufficiency should be discussed with each patient. The selection of surgical method for glottic insufficiency depends on experience of the surgeon, available anesthesia, existing facilities, and cost effectiveness of the treatment modality.