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A second set of eight larynges was used to evaluate medialization laryngoplasty using a Silastic implant without and with arytenoid adduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>IL and ML led to comparable decreases in phonation threshold flow (PTF), phonation threshold pressure (PTP), and phonation threshold power (PTW). ML\u2010AA led to significant decreases in PTF (<jats:italic>P<\/jats:italic> = .008), PTP (<jats:italic>P<\/jats:italic> = .008), and PTW (<jats:italic>P<\/jats:italic> = .008). IL and ML led to approximately equal decreases in percent jitter and percent shimmer. ML\u2010AA caused the greatest increase in signal\u2010to\u2010noise ratio. ML\u2010AA discernibly decreased frequency (<jats:italic>P<\/jats:italic> = 0.059); a clear trend was not observed for IL or ML. IL significantly reduced mucosal wave amplitude (<jats:italic>P<\/jats:italic> = 0.002), whereas both ML and ML\u2010AA increased it. All procedures significantly decreased glottal gap, with the most dramatic effects observed after ML\u2010AA (<jats:italic>P<\/jats:italic> = 0.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>ML\u2010AA led to the greatest improvements in phonatory parameters. IL was comparable to ML aerodynamically and acoustically, but caused detrimental changes to the mucosal wave. Incremental improvements in parameters recorded from the same larynx were observed after ML and ML\u2010AA. To ensure optimal acoustic outcome, the arytenoid must be correctly rotated. This study provides objective support for the combined ML\u2010AA procedure in tolerant patients. 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