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Consideration of vocal fold position in unilateral vocal fold paralyses

  • Laryngology
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Abstract

The objective of this study was to improve the evaluation of unilateral vocal fold paralyses (uVFP) by means of an area measurement of the glottic plane, which describes the position of the paralysed vocal fold. The area measurements were related to electromyographic findings and clinical outcome (recovery, voice quality). In 56 patients (33 women and 23 men), uVFP were confirmed by endolaryngeal electromyography (EMG) of the paralysed vocal fold and cricothyroid muscles (CT). The EMG response was classified on a 4-point scale (from 0 to 3). Vocal fold position was divided into ‘paramedian’ and ‘intermediate’ and additionally quantified by measurement of the glottic area. An ‘area quotient’ (AQ) was calculated and related to the EMG findings and clinical outcome. Voice qualities were objectified regarding their additive noise (breathiness) and irregularity (roughness) using the ‘Göttingen Hoarseness Diagram’. The majority of uVFP was due to iatrogenic lesions. The AQ of classically graduated ‘paramedian’ and ‘intermediate’ vocal fold positions was significantly different but did not correlate with objective voice quality values. There were no significant correlations regarding EMG findings, duration or recovery from paralyses. Laryngeal EMG remains the gold standard for verifying uVFP. But EMG did not correlate significantly with AQ or functional outcome of uVFP. The measurement of an AQ is suitable for obtaining continuous data describing the position of paralysed vocal folds beyond the terms ‘paramedian’ or ‘intermediate’ and provides the basis for clinical evaluations of diagnostic tools and therapeutic interventions.

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References

  1. Clerf LH, Baltzell WH (1953) Re-evaluation of Semon’s hypothesis. Laryngoscope 63(8):693–699

    Article  CAS  PubMed  Google Scholar 

  2. Grossmann M (1897) Experimentelle Beiträge zur Lehre von der „Posticuslähmung“. Arch LaryngRhinol 6:282–360

    Google Scholar 

  3. Dedo HH (1970) The paralyzed larynx: an electromyographic study in dogs and humans. Laryngoscope 80(10):1455–1517

    Article  CAS  PubMed  Google Scholar 

  4. Woodson GE (1993) Configuration of the glottis in laryngeal paralysis. I: Clinical study. Laryngoscope 103(11):1227–1234

    Article  CAS  PubMed  Google Scholar 

  5. Koufman JA, Walker FO, Joharji GM (1995) The cricothyroid muscle does not influence vocal fold position in laryngeal paralysis. Laryngoscope 105(4):368–372

    Article  CAS  PubMed  Google Scholar 

  6. Nawka T, Anders LC, Wendler J (1994) Die auditive Beurteilung heiserer Stimmen nach dem RBH-system. Sprache-Stimme-Gehör 18:130–133

    Google Scholar 

  7. Fröhlich M, Michaelis D, Strube HW, Kruse E (2000) Acoustic voice analysis by means of the hoarseness diagram. J Speech Lang Hear Res 43:706–720

    Article  PubMed  Google Scholar 

  8. Friedman AD, Burns JA, Heaton JT, Zeitels SM (2010) Early versus late injection medialization for unilateral vocal cord paralysis. Laryngoscope 120:2042–2046

    Article  PubMed  Google Scholar 

  9. Sanabria A, Silver CE, Suárez C et al (2013) Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature. Eur Arch Otorhinolaryngol 270:2383–2395

    Article  PubMed  Google Scholar 

  10. Inagi K, Khidr AA, Ford CN, Bless DM, Heisey DM (1997) Correlation between vocal functions and glottal measurements in patients with unilateral vocal fold paralysis. Laryngoscope 107(6):782–791

    Article  CAS  PubMed  Google Scholar 

  11. Kirchner JA (1966) Atrophy of laryngeal muscles in vagal paralysis. Laryngoscope 76(11):1753–1765

    Article  CAS  PubMed  Google Scholar 

  12. Kirchner JA (1977) Intrathoracic injury to the motor nerve supply of the larynx. Acta Otolaryngol 83(1–2):163–169

    Article  CAS  PubMed  Google Scholar 

  13. Grossmann M (1906) Beitrag zur Lehre von der wechselseitigen funktionellen Beziehung der Kehlkopfmuskeln untereinander. Arch Laryng Rhinol 18:463–474

    Google Scholar 

  14. Crumley RL (1989) Laryngeal synkinesis: its significance to the laryngologist. Ann Otol Rhinol Laryngol 98(2):87–92

    Article  CAS  PubMed  Google Scholar 

  15. Stennert E (1979) I. Hypoglossal facial anastomosis: its significance for modern facial surgery. II. Combined approach in extratemporal facial nerve reconstruction. Clin Plast Surg 6(3):471–486

    CAS  PubMed  Google Scholar 

  16. Laskawi R, Drobik C, Baaske C (1994) Prognostic value of electrodiagnosis of Bell’s palsy. Laryngorhinootologie 73:338–341

    Article  CAS  PubMed  Google Scholar 

  17. Sataloff RT, Mandel S, Mann EA, Ludlow CL (2004) Practice parameter: laryngeal electromyography (an evidence-based review). Otolaryngol Head Neck Surg 130:770–779

    Article  PubMed  Google Scholar 

  18. Blitzer A, Crumley RL, Dailey SH et al (2009) Recommendations of the Neurolaryngology Study Group on laryngeal electromyography. Otolaryngol Head Neck Surg 140:782–793

    Article  PubMed  Google Scholar 

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Conflict of interest

All the authors declare that there are no conflicts of interest.

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Authors and Affiliations

  1. Division of Phoniatrics and Pedaudiology, Department of Otorhinolaryngology, University of Göttingen, Robert-Koch-Str. 40, 37077, Göttingen, Germany

    Arno Olthoff, Julia Steinle & Eberhard Kruse

  2. Department of Medical Statistics, University of Göttingen, Humboldtallee 32, 37073, Göttingen, Germany

    Thomas Asendorf

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  1. Arno Olthoff
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  2. Julia Steinle
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  3. Thomas Asendorf
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  4. Eberhard Kruse
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Correspondence to Arno Olthoff.

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Olthoff, A., Steinle, J., Asendorf, T. et al. Consideration of vocal fold position in unilateral vocal fold paralyses. Eur Arch Otorhinolaryngol 272, 923–928 (2015). https://doi.org/10.1007/s00405-014-3442-3

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  • DOI: https://doi.org/10.1007/s00405-014-3442-3

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