Elsevier

Journal of Voice

Volume 23, Issue 3, May 2009, Pages 396-398
Journal of Voice

Vocal Fold Paresis: Clinical and Electrophysiologic Features in a Tertiary Laryngology Practice

https://doi.org/10.1016/j.jvoice.2007.10.011Get rights and content

Summary

A retrospective chart review was performed at the senior author's voice disorder clinic to report the symptoms, signs, and laryngeal electromyography (LEMG) data of patients presenting with vocal fold paresis (VFP) in a tertiary laryngology academic practice over a 4-year period. Medical records of 739 patients presenting to the clinic with a chief complaint of dysphonia (for 2000–2004) were assessed. History intake forms, strobovideolaryngoscopy images, and LEMG reports were reviewed for all patients with a clinical diagnosis of VFP. Of the 739 patients presenting to the clinic with voice complaints, 195 were initially diagnosed with either vocal fold paralysis or VFP (26.4%). Only 13 out of 739 patients (1.8%) with voice complaints were diagnosed with LEMG-confirmed unilateral or bilateral VFP. The most common findings on strobovideolaryngoscopy were vocal fold bowing (70%), incomplete closure (62%), and increased vibratory amplitude (38%). Seventy percentage of the patients had unilateral VFP, predominantly isolated recurrent laryngeal nerve (RLN) disease. Only 9% had unilateral superior laryngeal nerve (SLN) involvement. The most common LEMG abnormality was reduced recruitment of motor units. In our voice center, VFP was a relatively uncommon diagnostic entity. Despite the low prevalence, VFP needs to be considered in all patients who present with dysphonia. Further study is needed to examine the prevalence of “abnormal” LEMG studies in an asymptomatic control population, and to determine the utility of LEMG in the evaluation and management of dysphonia. In the same way that strobovideolaryngoscopy has been critically evaluated in the past, there is also a need to determine how commonly LEMG contributes essential data which leads to a change in the patient's management and/or ultimate vocal outcome.

Introduction

Vocal fold paresis (VFP) has been a controversial subject—its incidence described as relatively common and underdiagnosed by some authors,1, 2 and rare/overdiagnosed by others.

Clinically, the characteristics of VFP have not been fully described and its diagnostic criteria are somewhat ill defined. As with laryngopharyngeal reflux disease (LPR) 20 years ago, VFP has been a lightning rod of controversy. “Believers” and “nonbelievers” have declared themselves over the past several years, as nascent evidence is beginning to accumulate which supports VFP as a real clinical entity. The senior author acknowledges that VFP is a true clinical entity that must be addressed, but is willing to concede that, like LPR, this entity can be overdiagnosed.

The aim of this study is to report the clinical and electrophysiological features of VFP in the senior author's tertiary laryngology practice. A retrospective review of patients presenting complaints, videostroboscopy characteristics, and laryngeal electromyography (LEMG) findings were examined to evaluate for a diagnosis and characterization of VFP.

Section snippets

Methods

A retrospective review of medical records of 739 patient charts from the senior author's clinic in the period between January 2000 and November 2004 was carried out. Patients who presented to the clinic with voice complaints such as dysphonia, vocal fatigue, and odynophonia were retrieved by current procedural terminology (CPT) code for videostroboscopy (31579), as videostroboscopy was performed on every patient with voice complaints. New patients who were diagnosed with unilateral or bilateral

Results

Of the 739 patients presenting to the clinic with voice complaints, 195 were clinically diagnosed with either vocal fold paralysis or VFP (26.4%). Nineteen of these 195 patients were tentatively given a clinical diagnosis of VFP. Of these 19 patients, 14 agreed to undergo LEMG. LEMG confirmed the diagnosis of unilateral or bilateral VFP in 13 of 739 patients (1.8%) with voice complaints (Table 1). One of the 14 patients with suspected VFP had a normal LEMG.

Of the 13 patients diagnosed with

Discussion

As VFP still seems to represent a controversial entity, we consider our point of view regarding VFP to be a “centrist,” or moderate stance. We acknowledge that VFP is indeed, a true clinical entity, but perhaps is not a common clinically relevant entity in patients presenting with dysphonia.

According to the analysis of dysphonic patients presenting to our voice clinic, only 1.8% had confirmed VFP. It is likely that a number of patients had “suspected paresis” based on history and/or LVES

Conclusion

VFP is an uncommon clinical entity in our practice, yet does play a role in a small number of patients who present with dysphonia. Patients present commonly with hoarseness, loss of volume, vocal fatigue, and loss of their upper vocal register. Females in their 40–50 years of age predominate versus their older male counterparts. Suggestive findings on videostroboscopy include incomplete closure, asymmetry of vocal fold abduction/adduction, and increased vibratory amplitude on the affected side.

References (6)

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