Dysphagia and Aspiration with Unilateral Vocal Cord Immobility: Incidence, Characterization, and Response to Surgical Treatment

Abstract

To objectively determine the incidence of dysphagia associated with unilateral vocal cord immobility (UVCI) and to evaluate the potential for response to vocal cord medialization, we made videofluoroscopic swallowing (VFS) recordings of patients with newly diagnosed UVCI and prospectively analyzed them in a blinded fashion using the Penetration-Aspiration Scale (PAS) and pharyngeal transport function measures. A subset of patients underwent vocal cord medialization and were evaluated with a postoperative VFS study. Comparison was made between preoperative and postoperative VFS results to study the effects of vocal cord medialization in this setting. Eighty-seven VFS recordings were studied in 64 adult patients with UVCI; 23 patients underwent VFS testing before and after vocal cord medialization. The UVCI was most commonly left-sided (53 cases) and most commonly resulted from thoracic or cardiac surgery (53.1%), followed by malignancy (15.6%). Overall, the median PAS score was 2.0 (25th-75th percentiles, 1.0-5.0), with 20 patients (31.3%) and 15 patients (23.4%) exhibiting penetration or aspiration, respectively. No significant differences in swallowing function were noted between surgical and nonsurgical causes of paralysis (PAS scores of 2.0 and 2.0, respectively; p = .901). The median PAS score improved from 4.0 to 3.0 (p = .395, Wilcoxon paired samples test) in patients studied after undergoing a vocal cord medialization procedure (6 laryngoplasties and 17 vocal cord injections). Laryngoplasty was not more successful than vocal cord injection in resolving aspiration (p = .27). Radiographically significant penetration or aspiration occurs in approximately one third of patients with UVCI, independent of the cause of paralysis. Vocal cord medialization may not be as effective as thought for eliminating aspiration in these patients.

Evaluation of Unilateral Vocal Fold Immobility

“…The prevalence of aspiration among patients with UVFI is 18-38 % [ [47][48][49]. Therefore, if a patient complains of dysphagia, or aspiration is suspected, further evaluation of their swallowing function should be performed.…”

Swallowing Evaluation in Patients with Unilateral Vocal Fold Immobility

“…Unilateral vocal fold immobility is the neurological disorder most frequently seen in the larynx [1,2]. Frequently, it is the consequence of lesion of the innervation [3], resulting in voice alteration as the most important manifestation.…”

“…If the paresis of the recurrent laryngeal nerve is associated with paresis of the superior laryngeal nerve, there is impairment of the pharyngeal constrictor musculature [6]. Patients with unilateral vocal fold immobility have laryngeal penetration and aspiration with a thin liquid bolus, but it is not frequent with a paste bolus [1,4].…”

Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-called iatrogenic Ortner’s (cardiovocal) syndrome

“…Truong et al [43] found that 65% patients had persistent vocal fold paralysis with a median follow-up time of 16.4 months, 27% of the 109 patients underwent surgical intervention for their airway, feeding or voice. Vocal cord medialization rendered the median penetration-aspiration scale score improved from 4.0 to 3.0 [3]. After surgical treatment, arytenoid adduction or silicone injection into the vocal cord was performed, the maximum phonation time improved from 4 s before treatment to 10 s after treatment [35].…”

“…It is predominantly complicated in thyroidectomy, a local lesion such as edema, rubor, hematoma and granuloma, or dysfunctional disorder without structural malformations [2]. The left vocal cord was more involved than the right, most commonly resulted from thoracic or cardiac surgery (53.1%) [3], cardiac surgery only (28.5%) and prolonged intubation/prematurity (16.7%) [4]. The underlying cause was neoplastic in 32%, surgical in 30%, idiopathic in 16%, traumatic in 11%, central in 8%, and infectious in 3% of the patients with unilateral vocal cord paralysis [5].…”