Analysis of laryngoscopic features in patients with unilateral vocal fold paresis

Abstract

4 Laryngoscope, 126:1831-1836, 2016.

Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis

“…6 In a 2013 study of stroboscopic examinations reviewed by otolaryngology residents with training on the concept of the interarytenoid spatial relationship, this factor positively predicted unilateral adductor thyroarytenoid/lateral cricoarytenoid paresis, including sidedness, when compared to LEMG findings. 7 Two recent prospective studies 8,9 also report reduced movement (extent of lateral motion) and reduced kinesis (rapidity of movement) as being significantly associated with paresis in a case series of 19 patients. Certain clinical features were found to be associated with specific sidedness when examined by expert laryngologists, 8 although not with acceptable inter-rater reliability when rated by less experienced trainees.…”

“…7 Two recent prospective studies 8,9 also report reduced movement (extent of lateral motion) and reduced kinesis (rapidity of movement) as being significantly associated with paresis in a case series of 19 patients. Certain clinical features were found to be associated with specific sidedness when examined by expert laryngologists, 8 although not with acceptable inter-rater reliability when rated by less experienced trainees. 9 In the current study, VF degeneration, glottic insufficiency, and mucosal wave anomalies were considered highly compelling in diagnosis of paresis, though not to the degree of motion anomalies.…”

Isolated Paresis of Laryngeal Adduction: What Are the Laryngoscopic and Stroboscopic Findings?

“…Findings on VLS depend on the degree of neurological impairment, the affected muscle or muscles, and the relative compensation from the unaffected muscles . Therefore, VLS findings are not specific and may include asymmetries in gross motion, glottal configuration, and mucosal wave formation during phonation . Furthermore, the distinction among neurological impairment, functional or behavioral disorder, and innocent laryngeal asymmetry on VLS is not straightforward …”

Vocal fold paresis

“…fold bowing (especially in a patient <50 years old), decreased abduction or adduction, axial tilt of the larynx, vertical height mismatch, phase lag, and asymmetric mucosal wave amplitudes and frequencies [1,3,4…”

“…However, the term 'paresis' for the purposes of this discussion denotes the preservation of some degree of mobility, thereby making it a discrete clinical entity from paralysis [1,3]. As such, the diagnosis of paresis becomes one that is attained either on visual inspection (endoscopy or stroboscopy) or in conjunction with neurodiagnostic testing [laryngeal electromyography (LEMG)] [4,5 && ,6 & ] (Fig. 1).…”