The Clinical Course of Idiopathic Bilateral Vocal Fold Motion Impairment in Adults: Case Series and Review of the Literature

Ghanem, Sara Abu; Junlapan, Attapon; Tsai, Shu Wei; Shih, Liang Chun; Sung, C. Kwang; Damrose, Edward J.

doi:10.1016/j.jvoice.2018.11.012

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…The treatment of patients with BVFI is complex, with a lack objective measures informing the decision to pursue operative intervention. Glottic opening is often not formally measured, 14 and objective respiratory measurements such as spirometry or body plethysmography are rarely employed, in part due to logistical barriers to formal testing especially when results will not alter the imminent airway plan 15–17 . There are multiple studies demonstrating limited inter‐rater reliability and lack of agreement between experts when evaluating laryngoscopic examinations, suggesting that diagnoses made based on laryngoscopic findings remain fairly subjective 18–20 .…”

Section: Discussionmentioning

confidence: 99%

Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility

et al. 2022

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Objective(1) To compare maximum glottic opening angle (anterior glottic angle, AGA) in patients with bilateral vocal fold immobility (BVFI), unilateral vocal fold immobility (UVFI) and normal larynges (NL), and (2) to correlate maximum AGA with patient‐reported outcome measures.MethodsPatients wisth BVFI, UVFI, and NL were retrospectively studied. An open‐source deep learning‐based computer vision tool for vocal fold tracking was used to analyze videolaryngoscopy. Minimum and maximum AGA were calculated and correlated with three patient‐reported outcomes measures.ResultsTwo hundred and fourteen patients were included. Mean maximum AGA was 29.91° (14.40° SD), 42.59° (12.37° SD), and 57.08° (11.14° SD) in BVFI (N = 70), UVFI (N = 70), and NL (N = 72) groups, respectively (p < 0.001). Patients requiring operative airway intervention for BVFI had an average maximum AGA of 24.94° (10.66° SD), statistically different from those not requiring intervention (p = 0.0001). There was moderate negative correlation between Dyspnea Index scores and AGA (Spearman r = −0.345, p = 0.0003). Maximum AGA demonstrated high discriminatory ability for BVFI diagnosis (AUC 0.92, 95% CI 0.81–0.97, p < 0.001) and moderate ability to predict need for operative airway intervention (AUC 0.77, 95% CI 0.64–0.89, p < 0.001).ConclusionsA computer vision tool for quantitative assessment of the AGA from videolaryngoscopy demonstrated ability to discriminate between patients with BVFI, UVFI, and normal controls and predict need for operative airway intervention. This tool may be useful for assessment of other neurological laryngeal conditions and may help guide decision‐making in laryngeal surgery.Level of EvidenceIII Laryngoscope, 133:2285–2291, 2023

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Section: Discussionmentioning

confidence: 99%

Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility

et al. 2022

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“…Although less prevalent, posterior glottic stenosis and cricoarytenoid ankylosis may result in BVFI as well 22 . Given the adequate approximation of medialized, immobile vocal folds, most patients with BVFI can phonate well 23 . The major problem resulting from BVFI is dyspnea due to reduced airway caliber, which may require emergent tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Cordotomy: A Systematic Review of Efficacy and Outcomes

et al. 2022

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Introduction: Glottic obstruction may arise secondary to bilateral vocal fold immobility (BVFI). Treatment options include a tracheostomy to bypass the site of obstruction as well as unilateral transverse cordotomy to alleviate the obstruction. The objective of this review is to determine the efficacy, adverse event profile, and long-term outcomes, including the need for tracheostomy, in patients undergoing unilateral cordotomy.Methods: The Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for this systematic review. A literature search of unilateral cordotomy was performed by searching PubMed, Cochrane Library, and Embase. Articles presenting cases of BVFI treated with unilateral cordotomy were included. Review articles, animal studies, non-English-language articles, and abstracts were excluded. Articles presenting cases of bilateral cordotomy or cordotomy with arytenoidectomy were excluded.Results: We identified 14 studies and 291 patients undergoing unilateral cordotomy. Sixty-eight patients had a prior tracheostomy in place at the time of cordotomy. The most common post-operative complication was granulation tissue formation (n = 39). Thirty-one patients developed glottic edema with subsequent dyspnea. Three patients developed scarring of the primary cordotomy site with the return to an obstructed airway. Nine patients required a post-cordotomy tracheostomy due to these complications. Five patients required a long-term tracheostomy and were unable to be decannulated.Conclusion: Unilateral cordotomy is an effective treatment for glottic obstruction with high post-operative decannulation rates. Adverse events including worsening glottic obstruction are uncommon, although edema and granulation tissue may develop in the post-operative period and necessitate close post-operative monitoring.

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Glottic Airway Stenosis

Rouhani

Sandhu²

2022

Textbook of Surgery of Larynx and Trachea

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The Clinical Course of Idiopathic Bilateral Vocal Fold Motion Impairment in Adults: Case Series and Review of the Literature

Cited by 3 publications

References 40 publications

Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility

Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility

Unilateral Cordotomy: A Systematic Review of Efficacy and Outcomes

Glottic Airway Stenosis

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