Contemporary Evaluation of Unilateral Vocal Cord Paralysis

Abstract

Unilateral vocal cord paralysis is a common finding in the practice of otolaryngology. Multiple etiologies have been described and have not changed appreciably in the last century. We attempted to characterize the contemporary evaluation of unilateral vocal cord paralysis, with consideration given to cost-effectiveness. Thirty-one board-certified otolaryngologists were interviewed to determine their typical evaluation protocol. The average cost of an evaluation totaled $1706.18, with a range of $112.56 to $3439.52. Otolaryngologists with more years of experience tended to pursue briefer and less expensive evaluations. The charts of 187 patients with a diagnosis of vocal paralysis from 1983 to 1991 were reviewed, of which 113 were evaluable. Eighty-four of these 113 (74%) were unilateral. In 48 of 84 cases (57%), the cause was apparent at the time of diagnosis. In 36 of 84 cases (43%), an evaluation was necessary. A diagnosis was achieved in 27 of these 36 instances (75%), with the most useful test being a chest roentgenogram (n = 13, 48%). The most common cause of unilateral vocal cord paralysis in our series was neoplasm (n = 34, 40%), followed by surgical trauma (n = 29, 35%). In no instance was a malignancy discovered subsequent to the initial evaluation. The most cost-efficient, inclusive diagnostic evaluation of unilateral vocal cord paralysis involves a stepwise progression through the tests that are most likely to yield a diagnosis, with endoscopy reserved for those cases in which simpler, less invasive tests have not indicated a cause.

Clinico-Etiolological Study of Vocal Cord Paralysis

“…Incidence of traumatic UVCP has been reported between 19 % [11] to 2 % [17]. Our results are in accordance with Terris [18] who found an incidence of 8 % for UVCP. For traumatic BVCP Feehery [5] reported an incidence of 32.6 % from Henry ford hospital and 26.7 % from Jefferson hospital.…”

Evaluation of Unilateral Vocal Fold Immobility

“…Injury to the RLN or vagus nerve may occur as a result of a wide range of etiology, including iatrogenic trauma, non-iatrogenic trauma, neoplasm, and systemic disease [1][2][3][4][5]. The lengthy course of the RLNs places them at high risk of injury, particularly the left nerve, which loops around the aorta.…”

Voz e posição de prega vocal em homens com paralisia unilateral de prega vocal

“…Nonetheless, it is believed that this data can be also associated to the fact that lung cancer is the number one cause of death by cancer among men from Rio Grande do Sul, and such state has the highest incidence and mortality rates in the country 23 . Other studies have also revealed that the non-laryngeal malignant disease, especially the pulmonary one, would be one of the main causes of vocal fold paralysis, being higher that thyroid surgery and iatrogenic causes 3,5 . In the authors' clinical practice, the phenomenon can also be informally observed, which converge with the significant results seen in the present study.…”

“…Notwithstanding, most vocal fold paralysis cases are among the elderly, and this is associated with a higher incidence of progressive neurological and non-laryngeal malignant diseases in this age range 2 . Vocal fold paralysis onset mean age is between 55 and 64 years 3,4 . Some studies 3,5 have shown that non-laryngeal malignant diseases, especially pulmonary, would be one of the main causes of vocal fold paralysis, being higher than thyroid surgery and iatrogenic causes.…”

“…Vocal fold paralysis onset mean age is between 55 and 64 years 3,4 . Some studies 3,5 have shown that non-laryngeal malignant diseases, especially pulmonary, would be one of the main causes of vocal fold paralysis, being higher than thyroid surgery and iatrogenic causes. The second most frequent cause for such paralysis would be trauma, either surgical or not, including trauma secondary to neck surgeries, such as thyroidectomies, tracheal intubation, thoracotomy, car accidents and wounds caused by weapons 3,5 .…”