Elsevier

Journal of Voice

Volume 20, Issue 2, June 2006, Pages 269-281
Journal of Voice

Mild Vocal Fold Paresis: Understanding Clinical Presentation and Electromyographic Findings

https://doi.org/10.1016/j.jvoice.2005.03.010Get rights and content

Summary

The implications of mild vocal fold hypomobility are incompletely understood. This study describes the clinical, electromyographic, and probable etiologic findings in patients who presented with complaints of dysphonia and whose physical examination revealed vocal fold paresis as a factor possibly contributing to their voice complaints. A retrospective chart review of all patients who presented to a tertiary laryngology referral center over a 13-month period, who had a clinical diagnosis of mild vocal fold hypomobility and who underwent laryngeal electromyography, were included in the study. A total of 22 patients completed the medical evaluation of their voice complaint. Of these patients, 19 (86.4%) were found to have evidence of neuropathy on laryngeal electromyography. The clinical picture indicated the following probable origins for the vocal fold paresis: goiter/thyroiditis (7/22 or 31.8%), idiopathic (4/22 or 18.2%), viral neuritis (4/22 or 18.2%), trauma (3/22 or 13.6%), and Lyme's disease (1/22 or 4.5%). This article describes the clinical entity of mild vocal fold hypomobility and associated flexible laryngoscopic, rigid strobovideolaryngoscopic, and laryngeal electromyographic findings.

Section snippets

Background and Significance

Mild vocal fold hypomobility is a common finding whose clinical significance is incompletely understood. The term “vocal fold hypomobility” describes a mobile vocal fold that exhibits mild sluggishness in adduction, abduction, and/or longitudinal tension that is observed with repetitive phonatory maneuvers and that is not immediately apparent with the assessment of the vocal folds at rest or with an assessment of vocal fold mobility during sustained phonation alone. Previous studies have

Methods

A retrospective chart review of all patients who presented to a university-based tertiary laryngology referral center for evaluation of dysphonia over the course of the 13-month period from March 2002 through April 2003 was performed. All patients had given consent to have their medical records used for research purposes at the time of their initial evaluation according to HIPAA regulations, and this study was approved by the Institutional Review Board at Graduate Hospital, Philadelphia, PA.

Results

Twenty-two patients were suspected of having vocal fold paresis on clinical examination (Table 1). All patients underwent laryngeal electromyographic testing of both recurrent laryngeal and superior laryngeal nerves, which totaled 88 nerves sampled. All patients completed the remainder of the diagnostic evaluation, including either computed tomography (CT) scan with contrast or magnetic resonance imaging (MRI) with gadolinium of the skull base through mediastinum and laboratory testing of

Discussion

The results of this study indicate that when mild hypomobility of a vocal fold is observed on physical examination, in at least 86.3% of the cases, evidence of a laryngeal neuropathy can be found on laryngeal electromyography. Interestingly, no muscle pattern of hypomobility can identify the paretic nerve or nerves accurately. When abnormalities in mobility of the vocal folds in the direction of action of the suspected paretic nerve are observed on laryngeal examination, an exact correlation

Conclusion

The results of this study indicate that mild vocal fold hypomobility is a clinical entity that usually is associated with findings of neuropathy on laryngeal electromyography. The clinical laryngeal examination can identify abnormalities in vocal fold mobility; however, the dynamics of asymmetrical muscle forces in the larynx do not allow one to accurately predict the dysfunctioning nerve based on physical examination findings alone. The most common electrical finding is abnormal motor unit

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    Presented at the American Laryngological Association Meeting at COSM, April 30–May 1, 2004.

    Supported by the Institutional Review Board at Graduate Hospital, Philadelphia, Pennsylvania.

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