Bilateral vocal fold immobility: a 13 year review of etiologies, management and the utility of the empey index

Abstract

BackgroundBilateral vocal fold immobility (BVFI) is a rare diagnosis causing dyspnea, dysphonia and dysphagia. Management depends on respiratory performance, airway patency, vocal ability, and quality-of-life priorities. The authors review the presentation, management and outcome in patients diagnosed with BVFI. The utility and efficacy of the Empey index (EI) and the Expiratory Disproportion Index (EDI) are evaluated as an objective monitoring tools for BVFI patients.MethodsA 13-year retrospective review was performed of BVFI patients at St. Michael’s Hospital, University of Toronto, a tertiary referral centre for laryngology.ResultsForty-eight patients were included; 46 presented with airway obstruction symptoms. Tracheotomy was required for airway management in 40 % of patients throughout the course of their treatment, which was reduced to 19 % at the end of the study period. Twenty-one patients underwent endoscopic arytenoidectomy/cordotomy. Non-operative management included continuous positive airway pressure devices. Pulmonary function testing was carried out in 29 patients. Only a portion of the BVFI patients met the defined upper airway obstruction criteria (45 % EI and 52 % EDI). Seven patients had complete pre- and post-operative PFTs for comparison and all seven had ratios that significantly improved post-operatively which correlated clinically.ConclusionThe EI and EDI have limited use in evaluating patients with who have variable upper airway obstruction, but may be helpful in monitoring within subject airway function changes.

Unilateral CO2 laser cordectomy for the treatment of bilateral vocal cord paralysis: a 10-years review

“…In our series, eighteen of tracheostomized patients (72%) were decanulated while seven patients (28%) were still on tracheostomy despite laser cordectomy. In a study by Maria K et al, 2 the decanulation rate was 42% while 5% failed decanulation. In another Italian study done on 13 patients of BVCP, 3 out of 10 failed decanulation.…”

Laryngeal pacing for bilateral vocal fold paralysis: Voice and respiratory aspects

“…The evaluation of FEF50/FIF50 ratio, EDI, TPI, and PQ failed to detect any significant difference in the respiratory function 6 months postimplantation compared with the preimplantation visit. Due to the limited sample size of our study and the inclusion of four of seven patients with a previous glottic enlargement, it is impossible to determine whether these parameters are not compatible with the evaluation of respiratory problems associated with the BVFP onset or whether the lack of statistically significant results is merely due to the limited sample size and heterogeneity of the study population. Accordingly, these parameters should be retested in larger and homogeneous cohorts, and the results compared with those of patients who underwent a standard glottic enlargement.…”

Therapy of bilateral vocal fold paralysis: Real world data of an international multi-center registry

“…decannulation rates show a high variability among the published results. This is most likely due to the methodological limitations of the most BVFP studies, in terms of design, sample size, control of biases, recruitment type, and selection criteria [7–11].…”