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Lu YT, Tseng WH, Chiu HL, Yang TL. Improvement in swallowing safety after injection laryngoplasty in patients with unilateral vocal paralysis complicated with aspiration. J Formos Med Assoc 2024; 123:179-187. [PMID: 37517935 DOI: 10.1016/j.jfma.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The benefit of injection laryngoplasty (IL) on voice for unilateral vocal fold paralysis (UVFP) is supported increasingly in literatures, yet less is known for swallowing. Also, prevalence of patient-reported dysphagia is substantially higher than instrumental studies. This prospective study focused on swallowing outcomes, with predetermined flexible endoscopic evaluation of swallowing (FEES) protocol that simulates daily life situation. METHODS Adult patients with UVFP and aspiration receiving IL were recruited. Voice outcome measurements, as well as swallowing outcomes including Eating Assessment Tool (EAT-10) and FEES, which challenged patients with different fluid volumes: 10 mL, 20 mL, and 90 mL cup sipping were evaluated. RESULTS Significant improvements were demonstrated in all voice outcomes. Significant changes were also presented inEAT-10 (P < 0.01). Pre-operatively, penetration-aspiration scale (PAS) was 1.5 ± 1.3, 1.9 ± 1.7 and 2.3 ± 1.8 for 10 mL, 20 mL and 90 mL serial sipping, and improved to 1.1 ± 0.3, 1.1 ± 0.4 and 1.4 ± 0.7 post-operatively (P < 0.01). Safe swallowing (PAS ≤ 2) was achieved in all, except for one patient, who presented with a post-injection PAS of 4 (material enters the airway, contacts the vocal folds, and is ejected from the airway) on 90 mL cup sipping, whose pre-injection PAS was 7 (residue in trachea). CONCLUSION Maintaining swallowing function suitable for social environment is important. Our results demonstrated the feasibility of the predetermined FEES protocol, and positive effects of IL on both voice and swallowing outcomes.
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Affiliation(s)
- Yu-Tung Lu
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hsiang-Ling Chiu
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
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Bhatta S, Gandhi S, Ghanpur AD, Ganesuni D. Etiology and presenting features of vocal cord paralysis: changing trends over the last two decades. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00322-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
The study was performed to evaluate the changing trends in etiology and presenting features of vocal cord paralysis (VCP) from March 1998 to March 2020.
Methods
Patient’s record collected from hospital database and divided into two groups, from March 1998 to March 2009 and from April 2009 to March 2020, to evaluate the changing trends in etiology and presenting features.
Results
Total of 711 VCP patients, 80.3% with unilateral (UVCP) and 19.7% with bilateral vocal cord paralysis (BVCP) included. The commonest etiology was non-surgical (57.1%) for UVCP and surgical (55.7%) for BVCP. The commonest surgical etiology was thyroid and parathyroid surgery for both UVCP (16.6%) and BVCP (38.5%). The commonest non-surgical etiology was idiopathic for UVCP (23.1%) and malignancies for BVCP (13.6%). There was increase in surgical etiology for both UVCP (39.3 to 45.3%) and BVCP (51.2 to 57.7%), and decrease in non-surgical etiology for both UVCP (60.7 to 54.6%) and BVCP (48.8 to 42.3%). The change in voice was most common presenting features for both UVCP (69.2%) and BVCP (92.8%). The frequency of the presenting features was comparable, with decrease in the duration of symptom onset over the time period.
Conclusion
The most common etiology for UVCP was idiopathic, and for BVCP was thyroid and parathyroid surgery. For both, UVCP and BVCP there was increasing trend for surgical and decreasing trend for non-surgical etiology. The change in voice was the most common presenting complain, with decrease in duration of symptom onset over time period.
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Zhu JE, Chen YC, Yu SY, Xu HX. The first experience of ultrasound-guided percutaneous microwave ablation for extracranial schwannoma of the cervical vagus nerve in carotid space and treatment response evaluation with contrast-enhanced imaging. Clin Hemorheol Microcirc 2021; 80:437-446. [PMID: 34864650 DOI: 10.3233/ch-211301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schwannoma is a benign tumor that originates from Schwann cells in the nerve sheathing of cranial, other peripheral, or autonomic nerves. Patients often present with painless mass as the chief complaint. The main symptoms of this tumor are related to its size and specific nerve origin. At present, the pretreatment diagnosis is mainly made by ultrasound, CT, MR, or biopsy, and the main treatment is surgical resection. We reported a new treatment method for cervical schwannoma in a 65-year-old woman with a history of non-small cell lung cancer (NSCLC). When the patient's neck mass was initially found with hoarseness and severe cough, it was considered as cervical lymph node metastasis of lung cancer due to her medical history. And she was diagnosed with schwannoma by core-needle biopsy after chemotherapy failed and the tumor shrank after the radiotherapy with no improvement of the clinical symptoms. After considering the physical condition, the patients were treated in our department for minimal invasiveness treatment. The patient was definitively diagnosed with cervical vagus schwannoma and was treated with ultrasound-guided microwave ablation of schwannoma under general anesthesia with systematic evaluation and improved preoperative examination. Her condition was stable, and the symptoms of severe cough disappeared after anesthesia resuscitation and the ablation. The tumor continued to shrink after the operation with no recurrence of cough symptoms. Ultrasound-guided percutaneous microwave ablation (MWA) for cervical vagus schwannomas might be a minimally invasive, effective, and relatively safe alternative to conventional treatment for those patients with severe symptoms.
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Affiliation(s)
- Jing-E Zhu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yun-Chao Chen
- Department of Medical Ultrasound, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Song-Yuan Yu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
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Abstract
BACKGROUND Vocal fold paralysis (VFP) can result from a variety of diseases or surgeries and has various causes. This study determined concurrent etiologies in patients who were treated in a teaching hospital (tertiary medical center). METHODS A retrospective review of medical records of patients with VFP from September 2010 to December 2019 was performed to determine the etiology. Patients with laryngeal/hypopharyngeal malignancies, those with incomplete examination and follow-up data were excluded from the study. During the follow-ups, cases involving recovery were also excluded. RESULTS One hundred and ninety-four patients with a determined etiology were included: 113 males and 81 females. Unilateral VFP was present in 178 patients, and 16 presented with bilateral VFP. The causes of unilateral VFP were surgical for 61.3%, neoplastic for 17.5%, idiopathic for 10.3%, traumatic for 1.5%, central for 4.7%, cardiovascular for 2%, radiation-induced for 1.5%, and inflammatory for 1%. Thyroidectomy was the most common surgery for unilateral VFP and was the cause for 54 patients. Lung cancer was responsible for 15 cases and was the most common neoplastic etiology of unilateral VFP. For those who presented with bilateral VFP, surgery was the most common cause and accounted for 56.3% of the incidences. In terms of gender, surgery was the most common cause for both sexes, accounting for 62 of 113 male patients and 57 of 81 female patients. Four cases recovered during the follow-ups and these were excluded. CONCLUSION Surgery and in particular, thyroidectomy, was the most common cause of VFP for these series. Central nervous system disorders were the cause of VFP (4.5%). Central nervous system disorders, especially cerebrovascular accidents that induced VFP, could not be neglected. Radiation-induced cranial nerve paralysis in the head and neck cancer was possible causes. The percentage for the causes of unilateral VFP, surgery increased and the percentage for neoplasm decreased for Taiwan.
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Affiliation(s)
- Hsing-Won Wang
- The Graduate Institute of Clinical Medicine and Department of Otolaryngology, College of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei.,Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Cheng-Chieh Lu
- The Graduate Institute of Clinical Medicine and Department of Otolaryngology, College of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei
| | - Pin-Zhir Chao
- The Graduate Institute of Clinical Medicine and Department of Otolaryngology, College of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei
| | - Fei-Peng Lee
- The Graduate Institute of Clinical Medicine and Department of Otolaryngology, College of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei
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Abstract
This article discusses vocal fold paresis as a separate and distinct condition from vocal fold paralysis. The signs and symptoms of paresis may be different and less obvious than those for paralysis, so this condition is often misdiagnosed or underdiagnosed. Elements necessary to heighten clinical suspicion are included to assist in educating practitioners on these subtle findings. Once paresis is suspected, associated respiratory or sensory abnormalities also should be sought, because these may change the treatment plan when recognized. Utility of laryngeal electromyography is discussed along with potential treatment options for both the motor and often-present sensory symptoms.
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Affiliation(s)
- Chandra M Ivey
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA.
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Maier J, Abdulhady L, Glad H. Extracranial internal carotid artery tortuosity may cause vocal cord palsy. Acta Otolaryngol 2019; 139:304-308. [PMID: 30794032 DOI: 10.1080/00016489.2018.1554263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clinical practice made us suspect that vocal cord palsy (VCP) can be associated with extracranial internal carotid artery (ICA) tortuosity. OBJECTIVES To find evidence for a causative relation between ICA tortuosity and VCP. METHODS This single-center, retrospective study comprised 66 patients with VCP. A total of 45 patients without VCP served as control group. Patient charts were reviewed for etiology and side of VCP. CT scans were reviewed independently by two radiologists for imprint in the jugular vein (JV) caused by a tortuous ICA, considered an indirect sign of potential vagus nerve affection. RESULTS A total of 33 patients had idiopathic VCP. ICA tortuosity causing a JV imprint with >10% JV lumen reduction was found more frequently on the paretic sides of patients with idiopathic VCP (15-24%) than in controls (3-9%), with p<.05 for observer 2 and p=.07 for observer 1. In patients with idiopathic VCP and JV imprint with >10% JV lumen reduction on one or both sides (n = 9), both observers found JV imprint with >10% JV lumen reduction more frequently on the side of VCP (p<.05). CONCLUSIONS ICA tortuosity causing a JV imprint may be the cause of VCP in some of the cases of VCP currently regarded as idiopathic.
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Affiliation(s)
- Jens Maier
- Sydvestjysk Sygehus Esbjerg, Radiology Department, Esbjerg, Denmark
| | - Luka Abdulhady
- Radiology Department, Sjaellands Universitetshospital Køge, Køge, Denmark
| | - Henrik Glad
- Department of Otorhinolaryngology and Maxillofacial Surgery, Sjaellands Universitetshospital Køge, Køge, Denmark
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The incidence and recovery rate of idiopathic vocal fold paralysis: a population-based study. Eur Arch Otorhinolaryngol 2018; 276:153-158. [PMID: 30443781 DOI: 10.1007/s00405-018-5207-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the incidence and spontaneous recovery rate of idiopathic vocal fold paralysis (IVFP) and paresis (IVFp), and the impact of steroid treatment on rates of recovery. METHODS This retrospective cohort study included all patients with IVFP or IVFp within a large integrated health-care system between January 1, 2008 and December 31, 2014. Patient demographics and clinical characteristics, including time to diagnosis, spontaneous recovery status, time to recovery, and treatment, were examined. RESULTS A total of 264 patients were identified, 183 (69.3%) with IVFP and 81 (30.7%) with IVFp. Nearly all cases (96.6%) were unilateral and 89.8% of patients were over the age of 45. The combined (IVFP and IVFp) 7-year mean incidence was 1.04 cases per 100,000 persons each year with the highest 7-year mean annual incidence in white patients (1.60 per 100,000). The total rate of spontaneous recovery was 29.5%, where 21.2% had endoscopic evidence of resolution and 8.3% had clinical improvement in their voice without endoscopic confirmation. The median time to symptom resolution was 4.0 months. Use of steroids was not linked with spontaneous recovery in multivariable analyses. CONCLUSION The annual incidence of VFP (IVFP and IVFp) was 1.04 cases per 100,000 persons, with spontaneous recovery occurring in nearly a third of patients, regardless of steroid use.
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Kwon M, Bae MR, Lee YS, Roh JL, Choi SH, Nam SY, Kim SY. Idiopathic Unilateral Vocal Fold Paralysis in Older Patients: Characteristics in the Disease Course and Implication of Computed Tomography for Evaluation of Etiology. Ann Otol Rhinol Laryngol 2018; 127:823-828. [PMID: 30183334 DOI: 10.1177/0003489418797944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to compare the characteristics of idiopathic unilateral vocal fold paralysis (IUVFP) in elderly versus younger patients, including the diagnostic yield of computed tomography (CT) scans for identifying the structural causes of IUVFP. METHODS We retrospectively analyzed medical records of the patients initially diagnosed with IUVFP in a single referral tertiary hospital. We compared patients' baseline characteristics, initial symptoms, laryngoscopic findings, and prevalence of structural causes on CT scans with respect to age (younger, <65 years vs older, ⩾65 years). RESULTS One hundred forty-two patients were enrolled (90 younger, 52 older). Evident structural causes were more frequently found on CT in older patients than younger patients (40.4% vs 22.2%, P = .034). Among truly idiopathic cases (70 younger, 31 older), recovered vocal fold mobility was identified in 48.6% younger and 41.9% older patients ( P = .666). There was no statistically significant difference in the characteristics between unrecovered and recovered subjects of the older patients with true IUVFP (all P > .05). CONCLUSIONS The CT scans provided significantly higher diagnostic yields in older patients than younger patients. The degrees of symptoms and complications and likelihood of natural recovery did not significantly differ between younger and older patients with IUVFP.
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Affiliation(s)
- Minsu Kwon
- 1 Department of Otorhinolaryngology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Mi Rye Bae
- 2 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon Se Lee
- 2 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- 2 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- 2 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- 2 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- 2 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Khaku A, Patel V, Zacharia T, Goldenberg D, McGinn J. Guidelines for radiographic imaging of cranial neuropathies. EAR, NOSE & THROAT JOURNAL 2018; 96:E23-E39. [PMID: 29121382 DOI: 10.1177/0145561317096010-1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Disruption of the complex pathways of the 12 cranial nerves can occur at any site along their course, and many, varied pathologic processes may initially manifest as dysfunction and neuropathy. Radiographic imaging (computed topography or magnetic resonance imaging) is frequently used to evaluate cranial neuropathies; however, indications for imaging and imaging method of choice vary considerably between the cranial nerves. The purpose of this review is to provide an analysis of the diagnostic yield and the most clinically appropriate means to evaluate cranial neuropathies using radiographic imaging. Using the PubMed MEDLINE NCBI database, a total of 49,079 articles' results were retrieved on September 20, 2014. Scholarly articles that discuss the etiology, incidence, and use of imaging in the context of evaluation and diagnostic yield of the 12 cranial nerves were evaluated for the purposes of this review. We combined primary research, guidelines, and best practice recommendations to create a practical framework for the radiographic evaluation of cranial neuropathies.
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Affiliation(s)
- Aliasgher Khaku
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Dr., MC H091, Hershey, PA 17033-0850, USA
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Bilici S, Yildiz M, Yigit O, Misir E. Imaging Modalities in the Etiologic Evaluation of Unilateral Vocal Fold Paralysis. J Voice 2018; 33:813.e1-813.e5. [PMID: 29785934 DOI: 10.1016/j.jvoice.2018.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This study aimed to investigate the roles of computed tomography (CT) and neck ultrasonography (US) in evaluating unilateral vocal fold paralysis (UVFP) of unknown etiology and to compare our results with those of other studies to assess the differences in etiology of UVFP. METHODS We investigated the medical records of 202 eligible patients with UVFP. In total, 168 underwent chest CT, 118 underwent neck CT, and 108 underwent head CT. One hundred and three patients were also evaluated with high-resolution neck US. The etiologic causes of UVFP were also determined. RESULTS Of the 202 eligible patients, the occult cause of the UVFP was determined in 96 patients (47.5%). Idiopathic causes were the most common etiologies (n = 106). In occult causes group, chest lesions were the most common diseases causing paralysis (52 cases) and included lung cancer (n = 28) and mediastinal malignancy (n = 8). More than half of the neck lesions were of thyroid origin. Of the 18 thyroid lesions, 12 were thyroid malignancies. Chest CT had an intermediate yield of 30.9% (52 of 168). Neck US had a diagnostic yield close to that of neck CT (26.2%). CONCLUSION UVFP may result mainly from idiopathic, lung cancer, mediastinal, and thyroid malignancies. The initial use of neck US as an alternative to CT may be advocated for the determination of diseases resulting in UVFP.
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Affiliation(s)
- Suat Bilici
- Department of Otorhinolaryngology-Head and Neck Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Muhammet Yildiz
- Department of Otorhinolaryngology-Head and Neck Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Ozgur Yigit
- Department of Otorhinolaryngology-Head and Neck Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Esra Misir
- Department of Otorhinolaryngology-Head and Neck Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
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Abstract
George London was one of the most compelling vocal artists of the early twentieth century. At the age of 47, the great bass-baritone retired from singing. It has been suggested that the premature ending of his operatic career was due to unilateral vocal cord palsy (UVCP). When London retired, the common belief was that this UVCP was caused by viral hepatitis, although there is no evidence to support such an etiology. London's medical records eliminate the possible etiology of a neck neoplasm, and the long period of time between a heart attack he experienced and his diagnosis of UVCP makes a cardiovascular etiology an unlikely causative factor. London's relatively young age, the diagnosis of laryngitis prior to his UVCP, and the course of his disease indicate that the underlying cause of the termination of his singing career was post-viral neuropathy. This paper describes the clinical evidence related to London's vocal cord function and explores the possible causes for his UVCP, which apparently led to his early retirement.
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Affiliation(s)
- Irit Duek
- Department of Otolaryngology Head and Neck Surgery, The Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
- Rappaport Institute of Medicine and Research, The Technion–Israel Institute of Technology, Haifa, Israel
| | - Jacob T. Cohen
- Department of Otolaryngology Head and Neck Surgery, The Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
- Rappaport Institute of Medicine and Research, The Technion–Israel Institute of Technology, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, The Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
- Rappaport Institute of Medicine and Research, The Technion–Israel Institute of Technology, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
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Our Experience of Medialization Thyroplasty with Freeze-Dried Cadaveric Human Fascia Lata in Unilateral True Vocal Cord Paralysis. Trauma Mon 2017. [DOI: 10.5812/traumamon.63141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Vij S, Gupta AK, Vir D. Voice Quality Following Unilateral Vocal Fold Paralysis: A Randomized Comparison of Therapeutic Modalities. J Voice 2017; 31:774.e9-774.e21. [DOI: 10.1016/j.jvoice.2017.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
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Mau T, Pan HM, Childs LF. The natural history of recoverable vocal fold paralysis: Implications for kinetics of reinnervation. Laryngoscope 2017; 127:2585-2590. [PMID: 28608475 DOI: 10.1002/lary.26734] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patients with unilateral vocal fold paralysis (UVFP) are commonly told to wait 12 months for spontaneous recovery. This study aims to 1) determine the time to vocal recovery in UVFP, 2) use that data to develop a neurophysiologically plausible model for recovery, and 3) use the model to generate meaningful predictions for patient counseling. STUDY DESIGN Case series with de novo mathematical modeling. METHODS Patients with UVFP who could pinpoint a discrete onset of vocal improvement were identified. The time-to-recovery data were modeled by assuming an "early" recovery group with neuropraxia and a "late" recovery group with more severe nerve injury. For the late group, a two-stage model was developed to explain the time to recovery: regenerating axons must cross the site of injury in stage 1 (probabilistic), followed by unimpeded regrowth to the larynx in stage 2 (deterministic). RESULTS Of 727 cases of UVFP over a 7-year period, 44 reported spontaneous recovery with a discrete onset of vocal improvement. A hybrid distribution incorporating the two stages (exponentially modified Gaussian) accurately modeled the time-to-recovery data (R2 = 0.918). The model predicts 86% of patients with recoverable UVFP will recover within 6 months, with 96% recovering within 9 months. Earlier vocal recovery is associated with recovery of vocal fold motion and younger age. CONCLUSIONS Waiting 12 months for spontaneous recovery is probably too conservative. Repair across the site of injury, and not regrowth to larynx, is likely the rate-determining step in reinnervation, consistent with other works on peripheral nerve regeneration. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2585-2590, 2017.
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Affiliation(s)
- Ted Mau
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Hao-Min Pan
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Lesley F Childs
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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15
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Patel VA, Zacharia TT, Goldenberg D, McGinn JD. End-organ radiographic manifestations of cranial neuropathies: A concise review. Clin Imaging 2017; 44:5-11. [PMID: 28364580 DOI: 10.1016/j.clinimag.2017.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/02/2017] [Accepted: 03/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cranial neuropathies are a spectrum of disorders associated with dysfunction of one or more of the twelve cranial nerves and the subsequent anatomic structures they innervate. OBJECTIVE The purpose of this article is to review radiographic imaging findings of end-organ aberrations secondary to cranial neuropathies. METHOD All articles related to cranial neuropathies were retrieved through the PubMed MEDLINE NCBI database from January 1, 1991 to August 31, 2014. These manuscripts were analyzed for their relation to cranial nerve end-organ disease pathogenesis and radiographic imaging. RESULTS The present review reveals detectable end-organ changes on CT and/or MRI for the following cranial nerves: olfactory nerve, optic nerve, oculomotor nerve, trochlear nerve, trigeminal nerve, abducens nerve, facial nerve, vestibulocochlear nerve, glossopharyngeal nerve, vagus nerve, accessory nerve, and hypoglossal nerve. CONCLUSION Radiographic imaging can assist in the detailed evaluation of end-organ involvement, often revealing a corresponding cranial nerve injury with high sensitivity and diagnostic accuracy. A thorough understanding of the distal manifestations of cranial nerve disease can optimize early pathologic detection as well as dictate further clinical management.
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Affiliation(s)
- Vijay A Patel
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Thomas T Zacharia
- Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Johnathan D McGinn
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
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Busto-Crespo O, Uzcanga-Lacabe M, Abad-Marco A, Berasategui I, García L, Maraví E, Aguilera-Albesa S, Fernández-Montero A, Fernández-González S. Longitudinal Voice Outcomes After Voice Therapy in Unilateral Vocal Fold Paralysis. J Voice 2016; 30:767.e9-767.e15. [DOI: 10.1016/j.jvoice.2015.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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17
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Pei YC, Li HY, Chen CL, Wong AMK, Huang PC, Fang TJ. Disease Characteristics and Electromyographic Findings of Nonsurgery-Related Unilateral Vocal Fold Paralysis. Laryngoscope 2016; 127:1381-1387. [DOI: 10.1002/lary.26329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- Center of Vascularized Tissue Allograft; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
- Healthy Aging Research Center; Chang Gung University; Taoyuan Taiwan
| | - Hsueh-Yu Li
- Department of Otolaryngology Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Cheng-Lun Chen
- Department of Physical Medicine and Rehabilitation; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Alice M. K. Wong
- Department of Physical Medicine and Rehabilitation; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- Healthy Aging Research Center; Chang Gung University; Taoyuan Taiwan
| | - Pei-Chi Huang
- Department of Physical Medicine and Rehabilitation; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Tuan-Jen Fang
- Department of Otolaryngology Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
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Chang WH, Fang TJ, Li HY, Jaw FS, Wong AMK, Pei YC. Quantitative electromyographic characteristics of idiopathic unilateral vocal fold paralysis. Laryngoscope 2016; 126:E362-E368. [DOI: 10.1002/lary.25944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/19/2016] [Accepted: 02/01/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Wei-Han Chang
- Institute of Biomedical Engineering; National Taiwan University; Taipei Taiwan
- Department of Physical Medicine and Rehabilitation; Chang Gung Memorial Hospital at Taipei; Taipei Taiwan
| | - Tuan-Jen Fang
- Department of Otolaryngology Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Hsueh-Yu Li
- Department of Otolaryngology Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering; National Taiwan University; Taipei Taiwan
| | - Alice M. K. Wong
- Department of Physical Medicine and Rehabilitation; Chang Gung Memorial Hospital at Taoyuan; Taoyuan Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
- Healthy Aging Research Center; Chang Gung University; Taoyuan Taiwan
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Kay-Rivest E, Mitmaker E, Payne RJ, Hier MP, Mlynarek AM, Young J, Forest VI. Preoperative vocal cord paralysis and its association with malignant thyroid disease and other pathological features. J Otolaryngol Head Neck Surg 2015; 44:35. [PMID: 26362432 PMCID: PMC4567777 DOI: 10.1186/s40463-015-0087-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/31/2015] [Indexed: 11/16/2022] Open
Abstract
Background Vocal cord paralysis (VCP) is found in both benign and malignant thyroid disease. This study was performed to determine if the presence of preoperative VCP predicts malignancy. Methods A retrospective analysis was performed on a cohort of 1923 consecutive patients undergoing thyroid surgery. The incidence of preoperative VCP was recorded. Patient and nodule characteristics were correlated with final pathology. Results 1.3 % of our cohort was found to have preoperative VCP. Malignant pathology was discovered in 76 % of patients with preoperative VCP. Among these patients, 72 % had a left sided paralysis. 10.5 % of patients with preoperative VCP had perineural invasion (PNI) on final pathology, compared to 1.1 % of patients with normal VC function. Conclusion Preoperative VCP appears to be a strong, though not an absolute, indicator of malignancy. Most VCP were on the left side. Assessing for preoperative VCP is crucial in all patients who need thyroid surgery, as even benign nodules can be accompanied by preoperative vocal cord paralysis.
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Affiliation(s)
- Emily Kay-Rivest
- Department of Otolaryngology - Head and Neck surgery, McGill University, Montreal, QC, Canada
| | - Elliot Mitmaker
- Department of General surgery, McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Michael P Hier
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Alex M Mlynarek
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Jonathan Young
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Véronique-Isabelle Forest
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada.
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Paddle PM, Mansor MB, Song PC, Franco RA. Diagnostic Yield of Computed Tomography in the Evaluation of Idiopathic Vocal Fold Paresis. Otolaryngol Head Neck Surg 2015; 153:414-9. [DOI: 10.1177/0194599815593268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 06/05/2015] [Indexed: 11/15/2022]
Abstract
Objective To determine the diagnostic yield of computed tomography (CT) in establishing an etiology in patients with idiopathic unilateral vocal fold paresis (IUVFP). To determine the proportion of CT scans yielding incidental findings requiring further patient management. Study Design Case series with chart review. Setting Tertiary laryngology practice. Subjects Laryngology clinic patients under the care of the 2 senior authors. Methods All clinic patients were identified who had a diagnosis of IUVFP and underwent CT of the skull base to the upper mediastinum from 2004 to 2014. Demographic, historical, examination, and investigation data were extracted. CT reports and endoscopic recordings were reviewed. Patients were excluded if there were insufficient clinical findings recorded or if there was a known neurologic disorder, complete vocal fold immobility, or bilateral involvement. Results A total of 174 patients with IUVFP who had also undergone contrast-enhanced CT were identified. Of the 174 patients, 5 had a cause for their paresis identified on CT. This equated to a diagnostic yield of 2.9% (95% confidence interval, 0.94% to 6.6%). Of the 174 patients, 48 had other incidental lesions identified that required further follow-up, investigation, or treatment. This equated to an incidental yield of 27.6% (95% confidence interval, 21.1% to 34.9%). Conclusion This is the second and largest study to evaluate the diagnostic yield of CT in the evaluation of IUVFP. It demonstrates a low diagnostic yield and a high incidental yield. These findings suggest that the routine use of CT in the evaluation of idiopathic vocal fold paresis should be given careful consideration and that a tailored approach to investigation with good otolaryngologic follow-up is warranted.
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Affiliation(s)
- Paul M. Paddle
- Harvard Medical School, Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Masaany B. Mansor
- Harvard Medical School, Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Phillip C. Song
- Harvard Medical School, Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ramon A. Franco
- Harvard Medical School, Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Rizvi MM, Singh RB, Jain A, Sarkar A. Asymptomatic aortic aneurysm causing right vocal cord palsy and hoarseness: A rare presentation. Anesth Essays Res 2015; 8:397-400. [PMID: 25886343 PMCID: PMC4258979 DOI: 10.4103/0259-1162.143157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vocal cord palsy (VCP) presenting as hoarseness of voice can be the first symptom of very serious and sinister common pathologies. But vocal cord palsy resulting from aortic aneurysm is a rare entity and still rarer is the right cord palsy due to aortic aneurysm. We are reporting a rare case in which a 52-year old male smoking for last 30 years having asymptomatic aortic aneurysm presented to us with hoarseness of voice. On Panendoscopy, no local pathology was found and CECT from base of skull to T12 was advised. CECT showed a large aneurysm involving ascending aorta and extending upto abdominal aorta with compression of the bilateral bronchi. CTVS consultation was sought and they advised for regular follow-up only. We are reporting this case to warn both the anaesthetist and the surgeon about the catastrophic complications if they are not alert in handling such cases.
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Affiliation(s)
- M M Rizvi
- Department of Anesthesiology, ELMCH, Lucknow, Uttar Pradesh, India
| | | | - Anuj Jain
- Department of Anesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Arindam Sarkar
- Department of Anesthesiology, ELMCH, Lucknow, Uttar Pradesh, India
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Muhoozi R, Yu F, Tang J, Wang X. Transient palsy of recurrent laryngeal nerve postresection of giant substernal goiter. Thorac Cardiovasc Surg Rep 2015; 3:51-4. [PMID: 25798363 PMCID: PMC4360679 DOI: 10.1055/s-0034-1368099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/11/2013] [Indexed: 11/04/2022] Open
Abstract
We report a case of a female patient aged 46 years with a history of nodular goiter for which she had a subtotal thyroidectomy 31 years ago. She was referred to the emergency department of our hospital because of dyspnea and chest pain for 20 days, then developed cyanosis and edema of the head and upper extremities. Chest X-ray revealed tracheal repulsion. Cervical and thoracic computed tomography showed a giant solid and a cystic mass in the anterior mediastinum and bilateral pleural effusion. The neck ultrasound did not show any thyroid masses. An exploratory thoracotomy with extensive resection considering the anatomical relation of the mass and the adjacent structures was planned. Immediately after the operation, the patient developed airway complications that resolved in 7 days. The tumor was confirmed pathologically as nodular goiter. The overall outcome of the patient was positive; she is healthy after more than 12 months of follow-up. This report examines the approach to diagnosis and management of one of the most common surgical complication associated with substernal goiters.
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Affiliation(s)
- Rwakaryebe Muhoozi
- Department of Cardiothoracic Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Fenglei Yu
- Department of Cardiothoracic Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingqun Tang
- Department of Cardiothoracic Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiang Wang
- Department of Cardiothoracic Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China ; Key Laboratory of Carcinogenesis and Cancer Invasion, Cancer Research Institute, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
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Chen DW, Young A, Donovan DT, Ongkasuwan J. Routine Computed Tomography in the Evaluation of Vocal Fold Movement Impairment without an Apparent Cause. Otolaryngol Head Neck Surg 2015; 152:308-313. [DOI: 10.1177/0194599814562720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/14/2014] [Indexed: 08/30/2023]
Abstract
ObjectiveRoutine computed tomography (CT) for vocal fold movement impairment (VFMI) without an apparent cause is common. However, given increased cancer risk associated with ionizing radiation exposure, our purpose is to evaluate the utility of routine scans for these patients.Study DesignRetrospective case series.SettingHouston, Texas.Subjects and MethodsA 5‐year review of patients with VFMI diagnosed at an academic institution was conducted. For patients without an apparent cause (eg, recent head, neck, or cardiothoracic surgery or known malignancy), CT head/neck and chest was performed to evaluate the recurrent laryngeal nerve course. Data included demographics, symptoms, radiography, and interventions. Statistical analyses were performed via χ2 analysis.ResultsOf 406 patients with VFMI, 47 (11%) patients had no apparent cause clinically. Routine CT revealed abnormalities in 10 (21%) patients, of which only 3 (6%) could account for VFMI: benign thyroid adenoma (1), papillary thyroid cancer (1), and an esophageal mass (1). The most common lesion detected involved the thyroid. Demographic data and symptom type were not significantly associated with detection of a VFMI‐attributable lesion on CT. Overall, routine CT did not identify a focal etiology in 94% patients with VFMI without an apparent cause.ConclusionRoutine pan‐CT evaluation failed to reveal an etiology in 94% of patients with VFMI without an apparent cause. Patients may be subjected to health risks associated with radiation exposure without significant diagnostic benefit. Further studies should consider more judicious use of CT in the context of risk factors and safer imaging modalities as the initial diagnostic step.
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Affiliation(s)
- Diane W. Chen
- Department Otolaryngology–Head & Neck Surgery Baylor College of Medicine Houston Texas USA
| | - Alex Young
- Department Otolaryngology–Head & Neck Surgery Baylor College of Medicine Houston Texas USA
| | - Donald T. Donovan
- Department Otolaryngology–Head & Neck Surgery Baylor College of Medicine Houston Texas USA
| | - Julina Ongkasuwan
- Department Otolaryngology–Head & Neck Surgery Baylor College of Medicine Houston Texas USA
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Vocal cord paralysis: anatomy, imaging and pathology. Insights Imaging 2014; 5:743-51. [PMID: 25315036 PMCID: PMC4263806 DOI: 10.1007/s13244-014-0364-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/22/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022] Open
Abstract
Vocal cord paralysis (VCP) can be caused by any process that interferes with the normal function of the vagal nerves or recurrent laryngeal nerves. It may be a first sign of extensive and severe pathology. Radiologists must therefore be able to recognise the imaging findings of VCP and know the course of the vagal and recurrent laryngeal nerves. This review focuses on the anatomy and imaging evaluation of these nerves and thereby the possible sites for pathology causing VCP. The imaging characteristics and imaging mimics of VCP are discussed and cases from daily practice illustrating causes of VCP are presented. • Vocal cord paralysis may be the first presentation of severe pathology. • Radiologists must be aware of imaging characteristics and mimics of vocal cord paralysis. • Lesions along the vagal nerves and recurrent laryngeal nerves can cause vocal cord paralysis.
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Spataro EA, Grindler DJ, Paniello RC. Etiology and Time to Presentation of Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg 2014; 151:286-93. [PMID: 24796331 DOI: 10.1177/0194599814531733] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/25/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the etiology, laterality, and time to presentation of unilateral vocal fold paralysis (UVFP) at a tertiary care institution over 10 years. STUDY DESIGN Case series with chart review. SETTING Academic medical center. SUBJECTS AND METHODS All patients seen between 2002 and 2012 by the Department of Otolaryngology at the Washington University School of Medicine (WUSM), with a diagnosis of unilateral vocal fold paralysis, were included. Medical records were reviewed for symptom onset date, presentation date(s), and etiology of UVFP. RESULTS Of the patients, 938 met inclusion criteria and were included. In total, 522 patients (55.6%) had UVFP due to surgery; 158 (16.8%) were associated with thyroid/parathyroid surgery, while 364 (38.8%) were due to nonthyroid surgery. Of the patients, 416 (44.4%) had nonsurgical etiologies, 124 (13.2%) had idiopathic UVFP, and 621 (66.2%) had left-sided UVFP. The diagnosis was more common on the left side in cases of intrathoracic surgeries and malignancies, as expected, but also in idiopathic, carotid endarterectomy, intubation, and skull base tumors. In total, 9.8% of patients presented first to an outside otolaryngologist at a median time of 2.1 months after onset, but these patients presented to WUSM at a median time of 9.5 months. Overall, 70.6% of patients presented to a WUSM otolaryngologist within 3 months of onset. CONCLUSION Iatrogenic injury remains the most common cause of UVFP. Thyroidectomy remains the leading cause of surgery-related UVFP. Patients are typically seen within 3-4 months of onset; however, a significant delay exists for those referred to WUSM.
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Affiliation(s)
- Emily A Spataro
- Department of Otolaryngology-Head and Neck Surgery, Washington, University School of Medicine, St Louis, Missouri, USA
| | - David J Grindler
- Department of Otolaryngology-Head and Neck Surgery, Washington, University School of Medicine, St Louis, Missouri, USA
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington, University School of Medicine, St Louis, Missouri, USA
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Seyed Toutounchi SJ, Eydi M, Golzari SE, Ghaffari MR, Parvizian N. Vocal cord paralysis and its etiologies: a prospective study. J Cardiovasc Thorac Res 2014; 6:47-50. [PMID: 24753832 PMCID: PMC3992732 DOI: 10.5681/jcvtr.2014.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 01/10/2014] [Indexed: 01/02/2023] Open
Abstract
Introduction:
Vocal cord paralysis is a common symptom of numerous diseases and it may be due to neurogenic or mechanical fixation of
the cords. Paralysis of the vocal cords is just a symptom of underlying disease in some cases; so, clinical diagnosis of the underlying
cause leading to paralysis of the vocal cords is important. This study evaluates the causes of vocal cord paralysis.
Methods: In a prospective study, 45 patients with paralyzed vocal cord diagnosis were examined by tests such as examination of the pharynx, larynx,
esophagus, thyroid, cervical, lung, and mediastinum, brain and heart by diagnostic imaging to investigate the cause vocal cord paralysis.
The study was ended by diagnosing the reason of vocal cord paralysis at each stage of the examination and the clinical studies.
Results: The mean duration of symptoms was 18.95±6.50 months. The reason for referral was phonation changes (97.8%) and aspiration (37.8%)
in the subjects. There was bilateral paralysis in 6.82%, left paralysis in 56.82% and right in 63.36% of subjects. The type of vocal cord
placement was midline in 52.8%, paramedian in 44.4% and lateral in 2.8% of the subjects. The causes of vocal cords paralysis were
idiopathic paralysis (31.11%), tumors (31.11%), surgery (28.89%), trauma, brain problems, systemic disease and other causes (2.2%).
Conclusion: An integrated diagnostic and treatment program is necessary for patients with vocal cord paralysis. Possibility of malignancy should be excluded before marking idiopathic reason to vocal cord paralysis.
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Affiliation(s)
| | - Mahmood Eydi
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Ej Golzari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Nashmil Parvizian
- Department of ENT, Tabriz University of Medical Sciences, Tabriz, Iran
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Gupta J, Varshney S, Bist SS, Bhagat S. Clinico-etiolological study of vocal cord paralysis. Indian J Otolaryngol Head Neck Surg 2012; 65:16-9. [PMID: 24381912 DOI: 10.1007/s12070-012-0574-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/20/2012] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to identify patients of vocal cord paralysis and to establish an etiological diagnosis. Patients with vocal cord paralysis have been followed prospectively at a tertiary referral center. 120 patients identified with vocal cord paralysis by laryngeal endoscopy were evaluated clinically, radiologically and pathologically to make an etiological diagnosis. Those patients in whom no cause was found, a CT scan from base of skull to thorax was done before labeling them as idiopathic. Most of the patients presented in 5th (26.67 %) and 6th (21.67 %) decade. Males out numbered females in the ratio 2.3:1.0. The most common symptom of vocal cord paralysis was change in voice (98.21 %). Bilateral vocal cord palsy was found in 6.67 % patients and unilateral vocal cord palsy was found in 93.33 % patients. Among patients of unilateral vocal cord paralysis left vocal cord was paralyzed in 69.64 % and right cord in 30.36 %. Malignant (34.16 %) causes accounted for largest number of patients followed by central (15.00 %) and idiopathic causes (14.16 %). VCP has got a variable etiology which varies with the laterality of the vocal cord involvement. Malignant causes predominated in our series, occurring in 34.16 %, followed by central and idiopathic causes.
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Affiliation(s)
- Jaya Gupta
- Department of ENT, Himalayan Institute of Medical Sciences, HIHT University, Swami Rama Nagar, Jolly Grant, Doiwala, Dehradun, India
| | - Saurabh Varshney
- Department of ENT, Himalayan Institute of Medical Sciences, HIHT University, Swami Rama Nagar, Jolly Grant, Doiwala, Dehradun, India
| | - S S Bist
- Department of ENT, Himalayan Institute of Medical Sciences, HIHT University, Swami Rama Nagar, Jolly Grant, Doiwala, Dehradun, India
| | - Sanjeev Bhagat
- Department of ENT, Himalayan Institute of Medical Sciences, HIHT University, Swami Rama Nagar, Jolly Grant, Doiwala, Dehradun, India
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Badia PI, Hillel AT, Shah MD, Johns MM, Klein AM. Computed tomography has low yield in the evaluation of idiopathic unilateral true vocal fold paresis. Laryngoscope 2012; 123:204-7. [DOI: 10.1002/lary.23538] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2012] [Indexed: 11/09/2022]
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Porażenia krtani w materiale Poradni Foniatrycznej Warszawskiego Uniwersytetu Medycznego w latach 2000–2011. Otolaryngol Pol 2012; 66:313-7. [DOI: 10.1016/j.otpol.2012.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 06/28/2012] [Indexed: 11/17/2022]
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Paquette CM, Manos DC, Psooy BJ. Unilateral Vocal Cord Paralysis: A Review of CT Findings, Mediastinal Causes, and the Course of the Recurrent Laryngeal Nerves. Radiographics 2012; 32:721-40. [DOI: 10.1148/rg.323115129] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wang CP, Chen TC, Lou PJ, Yang TL, Hu YL, Shieh MJ, Ko JY, Hsiao TY. Neck ultrasonography for the evaluation of the etiology of adult unilateral vocal fold paralysis. Head Neck 2011; 34:643-8. [DOI: 10.1002/hed.21794] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2011] [Indexed: 11/09/2022] Open
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Garcia MDM, Magalhães FP, Dadalto GB, Moura MVTD. Avaliação por imagem da paralisia de pregas vocais. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000500012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Paralisia das pregas vocais é causa frequente de rouquidão, podendo ser secundária a várias lesões ao longo do trajeto do X par craniano e seus ramos, particularmente os nervos laríngeos recorrentes. Apesar de grande parte dos casos ser idiopática, os métodos de imagem são muito importantes na pesquisa de fatores etiológicos, tais como lesões neoplásicas da tireoide e esôfago com invasão secundária dos nervos laríngeos recorrentes. Além destas, outras anormalidades como aneurismas do arco aórtico e da artéria subclávia direita podem ser encontradas. É fundamental que o radiologista conheça a anatomia pertinente a esta região e as principais afecções que podem ocorrer, para que o estudo seja corretamente planejado, auxiliando o diagnóstico e o planejamento terapêutico. Além disso, como até 35% dos casos de paralisia da prega vocal são assintomáticos, o conhecimento dos sinais radiológicos que indicam esta condição é indispensável, cabendo ao radiologista alertar o médico assistente sobre os achados do exame. Neste trabalho realizamos uma revisão da anatomia e das principais doenças responsáveis pela paralisia de cordas vocais, demonstrando-as por meio de estudos de tomografia computadorizada e ressonância magnética de casos típicos. Mostramos, também, as alterações radiológicas próprias da laringe que indicam a presença de paralisia das pregas vocais.
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Affiliation(s)
| | - Fabiana Pizanni Magalhães
- Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Hospital de Pronto Socorro João XXIII, Brasil
| | - Gabriela Bijos Dadalto
- Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Axial Centro de Imagem, Brasil
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Idiopathic vocal fold paralysis: clinical course and outcomes. J Neurol Sci 2009; 284:56-62. [PMID: 19411079 DOI: 10.1016/j.jns.2009.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 03/26/2009] [Accepted: 04/02/2009] [Indexed: 11/20/2022]
Abstract
This investigation details the results of a retrospective chart review of 35 patients with idiopathic vocal fold paralysis. Clinical findings at presentation, as well as patient outcomes in both the short and long-term duration are comprehensively reported. Spontaneous improvement of vocal fold function was observed in 25% of patients with long-term follow up. Of those with unilateral paralysis, 27% elected to undergo surgical intervention for improvement of symptoms. Four out of the five (80%) patients with bilateral paralysis required surgical intervention, including tracheotomy to relieve severe dyspnea and stridor. Discussions regarding possible underlying, occult etiologies of idiopathic vocal fold paralysis are presented, and suggested sequential behavioral and surgical treatment strategies are introduced.
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Quantitative Assessment of Laryngeal Muscle Morphology After Recurrent Laryngeal Nerve Injury: Right vs. Left Differences. Laryngoscope 2008; 118:1768-70. [DOI: 10.1097/mlg.0b013e31817f1940] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES/HYPOTHESIS To identify clinical evidence regarding outcome and duration of unilateral idiopathic vocal fold paralysis (IVFP). STUDY DESIGN Literature review. METHODS Medline search using the terms "vocal fold paralysis," "laryngeal paralysis," "vagal paralysis," and "recurrent nerve paralysis" was performed. Results were cross-checked by substituting "palsy" and "paresis" in place of "paralysis," "cord" in place of "fold," and adding "idiopathic" to each term. Furthermore, papers antedating the period of time covered by Medline were identified in references of publications. Case series identified by means of these searches were examined for information regarding duration and outcome of IVFP. RESULTS Seven hundred seventeen cases are reported. Complete recovery of motion occurred in 36 +/- 22% (range, 13-83%) of individuals. Some recovery of motion (complete and partial) occurred in 39 +/- 20% (range, 19-83%). Complete recovery of voice occurred in 52 +/- 17% (range, 25-87%) of cases, some degree of recovery in 61 +/- 22% (range, 25-87%). Most cases appear to recover in well under a year, with rare instances of markedly delayed recovery. CONCLUSIONS Review of available evidence reveals a highly variable rate of return of motion in IVFP. The rate of return of normal voice is consistently higher, although similarly variable. The marked differences in rates of recovery among reports appears to be the result of variable definitions of recovery, oversimplified all-or-none notions of paralysis and recovery, and inconsistent reporting of time elapsed from onset of paralysis to evaluation. All of these factors should be addressed in future prospective studies to shed further light on the natural history of vocal fold paralysis.
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Badawey MRE, Punekar S, Zammit-Maempel I. Prospective study to assess vocal cord palsy investigations1. Otolaryngol Head Neck Surg 2008; 138:788-90. [DOI: 10.1016/j.otohns.2008.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 02/20/2008] [Accepted: 03/04/2008] [Indexed: 11/29/2022]
Abstract
Objectives To assess the investigation and clinical outcome of patients presenting with unexplained vocal cord palsy (VCP). Study Design and Methods A prospective cohort study designed to evaluate 86 patients with unexplained VCP presenting to our tertiary referral center. Results Twenty-four (36%) patients had positive findings on CT scanning. Twenty-one (24%) cases showed mediastinal adenopathy ± pulmonary mass. The other three cases were a thoracic aneurysm, prostatic metastasis below the skull base, and a post-cricoid tumor. Follow-up period was 18 to 66 months. Fifteen (24%) of the 62 patients with negative radiology recovered full vocal cord movement. Conclusion CT neck ± chest plays an important role in the evaluation of VCP patients. The majority of pertinent radiologic findings involve malignant neoplasm.
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Affiliation(s)
| | - Samad Punekar
- From Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
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Chen HC, Jen YM, Wang CH, Lee JC, Lin YS. Etiology of vocal cord paralysis. ORL J Otorhinolaryngol Relat Spec 2007; 69:167-71. [PMID: 17264533 DOI: 10.1159/000099226] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 08/25/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Vocal cord paralysis (VCP) is a sign of a certain underlying disease, a diagnosis which can be attributed to various causes. This study intends to analyze the contemporary etiology of VCP in a tertiary medical center. MATERIALS AND METHODS A retrospective review of medical records from June 2000 to December 2004 of hospitalized patients with VCP was done to determine the etiology. RESULTS Two hundred and ninety-one patients with a determined etiology were identified, consisting of 176 males and 115 females. Unilateral VCP was present in 259 patients, while 32 presented with bilateral VCP. The causes were surgical in 40.2%, neoplastic in 29.9%, idiopathic in 10.7%, traumatic in 8%, central in 3.8%, radiation-induced in 3.4%, inflammatory in 2%, cardiovascular in 1.7% and other causes in 0.3% of the cases. Thyroidectomy represented the most common surgery for VCP and was the cause in 57 patients. Lung cancer was responsible for 34 cases and was the most common neoplastic etiology. In males, neoplasm was the most common cause occurring in 63 of 176 males, whereas surgery was most frequent in 59 of 115 females. CONCLUSION Surgical trauma, mainly thyroidectomy, is the most common cause of VCP in hospitalized patients. The possibility of a neoplasm must be ruled out before VCP is labeled idiopathic. A benign thyroid tumor could also cause VCP. Besides, radiation-induced cranial nerve paralysis in head and neck cancer may play a significant role.
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Affiliation(s)
- Hsin-Chien Chen
- Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Merati AL, Halum SL, Smith TL. Diagnostic Testing for Vocal Fold Paralysis: Survey of Practice and Evidence-Based Medicine Review. Laryngoscope 2006; 116:1539-52. [PMID: 16954976 DOI: 10.1097/01.mlg.0000234937.46306.c2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold paralysis continues to be a dominant topic in laryngology. Although the majority of cases can be attributed to a known etiology, a significant number of patients present without a clear precipitating event. Over 1,500 studies regarding vocal fold paralysis exist in the medical literature, although only a small percentage report on the use of serum or radiographic testing for the evaluation of idiopathic paralysis. Despite this, patients are routinely subjected to diagnostic evaluation to investigate the underlying cause. To characterize contemporary practice, a national survey of the American Broncho-Esophagological Association (ABEA) membership was undertaken. It is hypothesized that the current practice of diagnostic testing for idiopathic vocal fold paralysis is not well supported by an evidence-based medicine (EBM) review of the available medical literature. STUDY DESIGN The authors conducted a national survey, systematic EBM review of existing literature. METHODS Surveys were mailed to all active ABEA members; responses regarding practice specialization as well as serum/radiographic diagnostic preferences for idiopathic vocal fold paralysis were tabulated and subjected to statistical analysis. To compare contemporary practice with evidence in the available literature, an EBM review was first performed. Articles for evaluation were selected from a Medline search of English-language abstracts related to adult vocal fold paralysis. The publications were individually reviewed and an EBM level and grade were assigned and compared with the survey results. RESULTS Eighty-four of 249 active members responded with 76 (31%) replies submitted for analysis. Specific serum tests were advocated by 41 of 76 (54%) respondents, although the majority (52 of 65 [80%]) felt that they were only "occasionally" or "never" necessary. The most common tests were rheumatoid factor (38%), Lyme titer (36%), erythrocyte sedimentation rate (34%), and antinuclear antibody (33%). Fifty-one of 71(72%) felt that computed tomography (CT) was "always" or "often" necessary and 50 of 72 (69%) replied that chest radiography (CXR) was "always" or "often" necessary. There was no significant difference between CT and CXR ordering (P < .51). In contrast, magnetic resonance imaging (MRI) was described as "always" or "often" necessary in 28 of 71 (39%) of the surveys, significantly less than CT (P < .0001). There was no statistical impact of practice specialization on ordering of serum tests (P = .25) or imaging (P = .50 for CT; P = .46 for CXR; P = .45 for MRI). Following analysis of 1,510 vocal fold paralysis abstracts, 19 publications were found to be appropriate for an EBM review of serum testing with 15 available for review of radiographic imaging. Only one study presented level III evidence; the remainder were levels IV and V comprised of retrospective series and case reports. The evidence supporting serum or radiographic testing toward the evaluation of idiopathic vocal fold paralysis is given an overall grade of "C." CONCLUSIONS Serum and radiographic testing for the evaluation of vocal fold paralysis is supported by grade "C" evidence only. There are no existing prospective studies estimating the clinical impact of testing on diagnosis or patient outcome. Current practice, as estimated by a survey of the ABEA membership, is not well founded for serum testing and only by retrospective case series with regard to imaging. Further study into the nature of idiopathic vocal fold paralysis and outcomes assessment of diagnostic paradigms may improve clinical practice.
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Affiliation(s)
- Albert L Merati
- Division of Laryngology, Department of Otolaryngology and Communication Sciences and Zablocki VAMC, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Bielamowicz S, Stager SV. Diagnosis of Unilateral Recurrent Laryngeal Nerve Paralysis: Laryngeal Electromyography, Subjective Rating Scales, Acoustic and Aerodynamic Measures. Laryngoscope 2006; 116:359-64. [PMID: 16540889 DOI: 10.1097/01.mlg.0000199743.99527.9f] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE/HYPOTHESIS To determine whether specific laryngeal electromyography (LEMG) patterns in patients with unilateral vocal fold paralysis/paresis (UVFP) are related to etiology of injury, time from onset of injury, patient perception of symptom severity, acoustic measures, and laryngeal aerodynamic measures. STUDY DESIGN This is a retrospective review of 75 patients. METHODS Each patient received LEMG, acoustic and aerodynamic testing, and a subjective rating scale assessment (the Glottal Closure Index). Statistical analysis by groups were performed using both chi and single-factor analysis of variance testing. RESULTS An iatrogenic etiology was associated with poor tone on LEMG (P = .05). Those individuals evaluated after 3 months after onset demonstrated more nascent units, a sign of reinnervation, compared with individuals evaluated before 3 months (P < .02). Individuals with fewer normal motor units on LEMG had significantly higher mean translaryngeal air flows (P = .044). Individuals with poor recruitment had significantly shorter maximum phonation times (P = .034) and higher mean flows (P = .044). Individuals with better laryngeal tone as noted on LEMG had significantly lower mean flows (P = .06). CONCLUSIONS Specific LEMG patterns are related to the etiology of the UVFP and time course since recurrent laryngeal nerve injury. LEMG appears to reflect vocal fold muscle tone as seen on laryngeal function studies. In combination, these studies provide a cohesive assessment of laryngeal function in patients with UVFP.
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Affiliation(s)
- Steven Bielamowicz
- Voice Treatment Center, Division of Otolaryngology-Head and Neck Surgery, The George Washington University, Washington, DC 20036, USA.
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Tiago RSL, Patrocínio SJ, dos Anjos PSF, Ribeiro JT, Gil FM, Denunci FV. [Vocal fold paralysis in children: diagnostic and management from a case report]. Braz J Otorhinolaryngol 2005; 71:382-5. [PMID: 16446947 PMCID: PMC9450595 DOI: 10.1016/s1808-8694(15)31341-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Vocal fold paralysis accounts for 10% of the larynx congenital abnormality, being the second most common cause of laryngeal stridor in childhood. As to unilateral vocal fold paralysis, the main cause is left-sided iatrogenic injury to the recurrent laryngeal nerve, secondary to surgery to correct the patent ductus arteriosus. In this study we reviewed the literature, reporting a case of a child who, after having undergone surgery to close the patent ductus arteriosus, evolved with breathing difficulty and dysphonia. We suggest that flexible fiberoptic laryngoscopy is carried out pre- and post surgery in children for whom heart surgery to correct congenital abnormalities is indicated, thus allowing for early diagnosis of vocal fold paralysis and the selection of the best management approach.
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Modi D, Fulham MJ, Mohamed A, Havas TE. Markedly Increased FDG Uptake in a Vocal Cord After Medialization With Teflon: PET/CT Findings. Clin Nucl Med 2005; 30:45-7. [PMID: 15604974 DOI: 10.1097/00003072-200501000-00018] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Dharmesh Modi
- Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
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Abstract
Etiologies of adult vocal paralysis are varied by the site of the lesion as well as the extent and cause of the damage. Most large series point to surgery and neoplastic causes for recurrent nerve paralysis. A detailed history is important when working up a patient with this voice disorder. Knowledge of the anatomy of the head, neck, and chest as well as the mechanisms behind vocal fold paralysis is essential in the evaluation and treatment of recurrent nerve paralysis. Many of the surgical and traumatic causes of hoarseness are from compression type injuries. Recovery is dependent on the type, extent, and site of nerve lesion. Familiarity with this data allows the otolaryngologist to tailor management to suit each patient with vocal fold paralysis.
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Affiliation(s)
- David Myssiorek
- Department of Otolaryngology and Communicative Disorders, The Long Island Jewish Medical Center, The Long Island Campus of the Albert Einstein College of Medicine, 270-05 76th Avenue, Suite 1120, New Hyde Park, NY 11040, USA.
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Torkian BA, Crumley RL. Granulomatous Inflammation and Nerve Necrosis in a Case of Apparent Idiopathic Vocal Fold Paralysis: Report of a Case. Laryngoscope 2004; 114:1271-5. [PMID: 15235359 DOI: 10.1097/00005537-200407000-00024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We will present clinical and pathologic findings of the recurrent laryngeal nerve of a 54-year-old man with apparent idiopathic vocal fold paralysis and discuss clinical and scientific implications of these findings. STUDY DESIGN Our design is in the format of a case report with emphasis on the clinical, intraoperative, histologic, and neuropathologic findings, followed by a discussion of contemporary theories of idiopathic unilateral vocal fold immobility and the implications of our findings. METHODS A 54-year-old man presented with a 2-year history of unilateral vocal fold motion impairment (VFMI) after an upper respiratory infection. Radiographic and laboratory data revealed no organic cause. The patient clinically appeared to have a classical unilateral vocal fold paralysis and had previously undergone collagen injection and medialization thyroplasty, each with only temporary improvement of voice. We performed ansa cervicalis-recurrent laryngeal nerve anastomosis. RESULTS Intraoperative dissection revealed an indurated and thickened section of nerve approximately 15 mm in length, located at the beginning of the intralaryngeal segment, near the cricothyroid joint. Segments of this nerve were submitted for histologic evaluation, revealing necrosis with granulomatous inflammation. Postoperative electromyography and videostrobolaryngoscopy were consistent with successful reinnervation from the ansa procedure. CONCLUSIONS The diagnosis of "idiopathic VFMI" likely represents a number of distinct pathologic entities. This case highlights our lack of understanding of idiopathic VFMI and raises many important questions regarding our current theories of this diagnosis. The clinical and pathologic implications are discussed, and continued investigation is recommended.
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Affiliation(s)
- Behrooz A Torkian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange 92868, USA
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Bhattacharyya N, Kotz T, Shapiro J. Dysphagia and aspiration with unilateral vocal cord immobility: incidence, characterization, and response to surgical treatment. Ann Otol Rhinol Laryngol 2002; 111:672-9. [PMID: 12184586 DOI: 10.1177/000348940211100803] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To objectively determine the incidence of dysphagia associated with unilateral vocal cord immobility (UVCI) and to evaluate the potential for response to vocal cord medialization, we made videofluoroscopic swallowing (VFS) recordings of patients with newly diagnosed UVCI and prospectively analyzed them in a blinded fashion using the Penetration-Aspiration Scale (PAS) and pharyngeal transport function measures. A subset of patients underwent vocal cord medialization and were evaluated with a postoperative VFS study. Comparison was made between preoperative and postoperative VFS results to study the effects of vocal cord medialization in this setting. Eighty-seven VFS recordings were studied in 64 adult patients with UVCI; 23 patients underwent VFS testing before and after vocal cord medialization. The UVCI was most commonly left-sided (53 cases) and most commonly resulted from thoracic or cardiac surgery (53.1%), followed by malignancy (15.6%). Overall, the median PAS score was 2.0 (25th-75th percentiles, 1.0-5.0), with 20 patients (31.3%) and 15 patients (23.4%) exhibiting penetration or aspiration, respectively. No significant differences in swallowing function were noted between surgical and nonsurgical causes of paralysis (PAS scores of 2.0 and 2.0, respectively; p = .901). The median PAS score improved from 4.0 to 3.0 (p = .395, Wilcoxon paired samples test) in patients studied after undergoing a vocal cord medialization procedure (6 laryngoplasties and 17 vocal cord injections). Laryngoplasty was not more successful than vocal cord injection in resolving aspiration (p = .27). Radiographically significant penetration or aspiration occurs in approximately one third of patients with UVCI, independent of the cause of paralysis. Vocal cord medialization may not be as effective as thought for eliminating aspiration in these patients.
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Affiliation(s)
- Neil Bhattacharyya
- Brigham and Women's Hospital, and Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
OBJECTIVE Persistent hoarseness due to recurrent laryngeal nerve paralysis (RLNP) reduces the quality of life unless it is adequately treated. This study examined the indications for phonosurgical intervention in patients with RLNP. MATERIALS AND METHODS The medical records of the Ehime University Hospital, Ehime, Japan, from October 1976 until December 1997 were reviewed retrospectively to identify patients with RLNP. The data collected included age, gender, paralyzed side, and cause of paralysis. RESULTS Four hundred and sixty-six patients with RLNP were identified: 262 males and 204 females. Unilateral RLNP was present in 422 patients, while 44 presented with bilateral RLNP. The incidence was relatively high in the 7th and 8th decades, and was twice as high in male patients as in female patients. The 466 patients were divided into 2 groups: Group 1 included 225 patients seen before January 1987, and Group 2 included 241 patients seen after this date. The number of patients with postoperative RLNP was significantly higher in Group 2 (124 of 239 patients) than in Group 1 (65 of 227 patients) (P<0.05). Surgery for cardiovascular disease, esophageal cancer, and skull base and thyroid gland tumors contributed to this increased incidence of postoperative RLNP. CONCLUSIONS Patients with persistent unilateral RLNP require appropriate treatment for hoarseness, regardless of its cause. Since the incidence of RLNP related to surgery was significantly increased in Group 2, phonosurgery has become more important for improving the quality of life of these patients.
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Affiliation(s)
- Eiji Yumoto
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University, 1-1-1, Honjo, Kumamoto 860-8556, Japan.
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Billante CR, Spector B, Hudson M, Burkard K, Netterville JL. Voice outcome following thyroplasty in patients with cancer-related vocal fold paralysis. Auris Nasus Larynx 2001; 28:315-21. [PMID: 11694375 DOI: 10.1016/s0385-8146(01)00101-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medialization laryngoplasty restores voice in patients with unilateral laryngeal paralysis. Of question was whether patients with vocal fold paralysis resulting from cancer or its treatment had as good a post-operative voice result as patients with vocal fold paralysis of benign etiology. The purpose of the present study was to compare post-operative perceptual, acoustic, aerodynamic, and quality of life data in these two patient groups. Twenty-eight patients with vocal fold paralysis secondary to malignancy or its treatment were age and gender-matched with patients with paralysis resulting from benign origin. Pre- and post-operative perceptual judgments of pitch, loudness and quality were rated independently by two speech-language pathologists. A digital audiotape of the patient's voice was analyzed using Soundscope software. Fundamental frequency, conversational intensity and perturbation were evaluated. Glottal flow rates in propositional speech, phonation times and extent of pitch and loudness ranges were also measured. Three quality of life surveys, the Short Form-36 general health survey, the Voice Handicap Index, and the Voice Outcomes Study were administered. Results of voice testing indicated that perceptual, acoustic and aerodynamic data were significantly improved 3 months after thyroplasty in all patients regardless of whether they had a history of cancer. Quality of life data, however, distinguished the two groups. In particular, the general health measure found a significant difference in physical functioning and overall vitality, although satisfaction with improved voice was equally appreciated in both patient groups. Of clinical significance is that though general health may differ, patients with cancer-related laryngeal paralysis can expect to have as good a voice outcome following thyroplasty as patients with paralysis of benign etiology.
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Affiliation(s)
- C R Billante
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.
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León X, Venegas MP, Orús C, Quer M, Maranillo E, Sañudo JR. [Glottic immobility: retrospective study of 229 cases]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2001; 52:486-92. [PMID: 11692963 DOI: 10.1016/s0001-6519(01)78240-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A retrospective study of the unilateral and bilateral vocal fold immobility cases diagnosed at our hospital between 1985 and 1998 was carried out. Of the 229 cases studied, vocal fold immobility was bilateral in 58 patients (25%), unilateral right in 60 (26%), and unilateral left 111 (49%). The most frequent etiologies in the bilateral cases were thyroid surgery (38%) and prolonged intubation (31%); idiopathic cases (32%) and thyroid surgery (23%) in the unilateral right cases; and idiopathic cases (28%) and extralaryngeal tumors (22%) in the unilateral left cases. Clinical compensation was achieved in more than 85% of cases of unilateral immobility when the etiology was idiopathic or due to surgical damage to the recurrent or vagus nerves, 70% when it was a prolonged intubation, 56% in neurological patients and 38% in extralaryngeal tumors. In patients with bilateral vocal fold immobility, 14% did not require any treatment, 34% had a permanent tracheostomy, and 52% recovered adequate naso-oral ventilation after surgery (tracheostomy only in 12 patients and arytenoidectomy in 18 patients).
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Affiliation(s)
- X León
- Servicio ORL, Hospital de la Santa Creu I Sant Pau, Avda. San Antoni M. Claret, 167, 08025 Barcelona
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Abstract
PURPOSE To describe a condition that occurs following an upper respiratory illness, which represents injury to various branches of the vagus nerve. Patients with this condition may present with breathy dysphonia, vocal fatigue, effortful phonation, odynophonia, cough, globus, and/or dysphagia, lasting long after resolution of the acute viral illness. The patterns of symptoms and findings in this condition are consistent with the hypothesis that viral infection causes or triggers vagal dysfunction. This so-called postviral vagal neuropathy (PVVN) appears to have similarities with other postviral neuropathic disorders, such as glossopharyngeal neuralgia and Bell's palsy. MATERIALS AND METHODS Five patients were identified with PVVN. Each patient's chart was reviewed, and elements of the history were recorded. RESULTS Each of the 5 patients showed different features of PVVN. CONCLUSIONS Respiratory infection can trigger or cause vocal fold paresis, laryngopharyngeal reflux, and neuropathic pain.
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Affiliation(s)
- M R Amin
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Pennsylvania, Hahnemann University School of Medicine, Philadelphia, PA, USA
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Zwetsch G, Filipovic M, Skarvan K, Todorov A, Seeberger MD. Transient Recurrent Laryngeal Nerve Palsy After Failed Placement of a Transesophageal Echocardiographic Probe in an Anesthetized Patient. Anesth Analg 2001; 92:1422-3. [PMID: 11375817 DOI: 10.1097/00000539-200106000-00013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G Zwetsch
- Department of Anesthesia, Division of Cardiothoracic Surgery, University of Basel/Kantonsspital, Basel, Switzerland
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