Diagnosis of vocal fold paresis: Current opinion and practice

Abstract

Surveyed expert laryngologists diagnose vocal fold paresis predominantly on stroboscopic examination. Gross motion abnormalities had the highest positive predictive value. Laryngeal electromyography was infrequently used to assess for vocal fold paresis.

In-Office Laryngeal Injection

“…Vocal fold paresis, or partial paralysis, is often challenging to identify because signs may be subtle or variable [14][15][16][17][18][19][20]. It is not rare for such a diagnosis to be made only provisionally.…”

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…”

“…Although electromyography is often stated as the 'gold standard' [7] for diagnosis of paresis and is touted as the only method to determine if a subtle vocal fold motion asymmetry is because of a neurologic insult [23], recent retrospective reviews reveal that 72% of laryngologists rely on videostroboscopy alone to make the diagnosis, whereas only 1.7% relied on LEMG alone [3], with most using LEMG as a confirmatory diagnostic test [13]. Such an observation is not surprising, since symptomatology is often what prompts endoscopy or stroboscopy to be performed first with scope findings, in turn, prompting further studies.…”

“…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.…”

On the problem of voice rehabilitation in the case of unilateral vocal fold paresis

“…В большинстве случаев с этой целью применяется ларингостробоскопия. Лишь 1,7% оториноларингологов в своей практике пользуются электромиографией, которая считается наиболее информативным методом в диффе-ренциальной диагностике между парезом и параличом гортани [8].…”