{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T16:36:05Z","timestamp":1793723765798,"version":"4.6.1"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine factors that direct decisions in the treatment of glottic insufficiency and propose a paradigm that may assist in treatment decision\u2010making in glottic insufficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective chart review was completed of 73 patients with vocal fold atrophy, presbyphonia, or vocal fold motion impairment, including diagnosis, Voice Handicap Index\u201010 (VHI\u201010), Voice Problem Impact Scales (VPIS), Glottal Function Index (GFI), Eating Assessment Tool\u201010 (EAT\u201010), Consensus Auditory Perceptual Analysis of Voice (CAPE\u2010V), 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\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      analysis and Wilcoxon signed\u2010rank tests were used to analyze outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Stimulability (Wald\u2009=\u200927.593;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), diagnosis (Wald\u2009=\u200926.496;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), CAPE\u2010V score (Wald\u2009=\u200914.875;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), glottal gap size (Wald\u2009=\u200912.045;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and VHI\u201010 score (Wald\u2009=\u200910.384;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) were the significant predictors of treatment decision. A decision\u2010making paradigm with these significant variables is proposed, based on the multivariate logistic regression. Utilizing this paradigm, most patients reported improvement from their first\u2010line treatment (86%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200951\/59) and some reported symptom resolution (24%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914\/59). Patients who completed first\u2010line treatment demonstrated significant improvement in VHI\u201010, GFI, and VPIS scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides preliminary insights into factors that impact treatment decision\u2010making 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\u2010making model in the management of glottal insufficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70108","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T12:19:43Z","timestamp":1757074783000},"page":"898-905","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Factors Directing Treatment Decision\u2010Making in the Management of Glottic Insufficiency"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5748-0976","authenticated-orcid":false,"given":"Desi","family":"Gutierrez","sequence":"first","affiliation":[{"name":"UCSF Voice &amp; Swallowing Center, Department of Otolaryngology\u2010Head and Neck Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob R.","family":"Wright","sequence":"additional","affiliation":[{"name":"UAB Voice Center, Department of Otolaryngology\u2010Head and Neck Surgery Heersink School of Medicine  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1923-0039","authenticated-orcid":false,"given":"Matthew R.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"University of Iowa Division of Otolaryngology\u2010Head and Neck Surgery  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Blake","family":"Simpson","sequence":"additional","affiliation":[{"name":"UAB Voice Center, Department of Otolaryngology\u2010Head and Neck Surgery Heersink School of Medicine  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7746-217X","authenticated-orcid":false,"given":"Lauren","family":"Timmons Sund","sequence":"additional","affiliation":[{"name":"USC Voice Center, Department of Otolaryngology\u2010Head and Neck Surgery Keck School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Gurmendi","sequence":"additional","affiliation":[{"name":"UAB Voice Center, Department of Otolaryngology\u2010Head and Neck Surgery Heersink School of Medicine  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edie R.","family":"Hapner","sequence":"additional","affiliation":[{"name":"UAB Voice Center, Department of Otolaryngology\u2010Head and Neck Surgery Heersink School of Medicine  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"StatPearls","author":"Onwordi L. 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