Vocal cord paralysis as primary and secondary results of malignancy. A prospective descriptive study

Abstract

Objective Vocal cord paralysis (VCP) may be caused by a primary malignancy and associated immune cross‐reactivity. We aimed to illuminate underlying causes of VCP and to assess if onconeural antibodies occur in association to VCP as an early predictor of cancer. Methods A prospective study was performed in patients with newly diagnosed VCP from 2014 to 2016. All patients underwent fiberoptic laryngoscopy, ultrasound of the neck and computed tomography (CT) of the neck and thorax. Patients with idiopathic VCP underwent neurological examination, positron emission tomography/CT, and serum analysis for onconeural antibodies. All patients were offered a one‐year clinical follow‐up. Results In total 53 patients fulfilled the inclusion criteria. Left VCP occurred in 37 (70%), right in 15 (28%), and bilateral in one patient (2%). The cause of VCP was cancer in 27 (51%) patients, of those 15 (56%) had VCP as the primary symptom, including all cases with laryngeal and esophageal cancer. Median time interval between VCP and cancer was 7 days (range 1–30). In 12 (23%) VCP was a secondary symptom. Lung cancer was the most common etiology, 14 of 27 (52%), 12 patients (86%) with non‐small cell lung cancer. Idiopathic VCP was diagnosed in 18 (34%) patients, of those nine patients had a neurological examination and were screened for well‐known onconeural antibodies, which were not detected. Reactions against Purkinje cell nuclei were seen in three patients, none showed symptoms or signs of cancer at follow‐up. Conclusions The causes of VCP were described. VCP was frequently the primary symptom, and also occurred as a secondary symptom of cancer. Exclusion of malignancy is important in patients with VCP. Level of Evidence 1b

Causes of Vocal Fold Paralysis

“…This result was comparable with those of previous studies. [5][6][7][8] The longer course of the left RLN may account for this variation. Studies showed that neoplasm, surgery, and idiopathic paralysis were the 3 main causes of unilateral VFP (Table 4).…”

“…Some studies show that the frequency of the various causes of VFP are changing. [6][7][8][9] The etiology of laryngeal paralysis has changed over time, with a decrease in the prevalence of malignancies and a recent increase in cases that are attributable to thyroid surgery.…”

“…Some studies show that the frequency of the various causes of VFP are changing. [6][7][8][9] The etiology of laryngeal paralysis has changed over time, with a decrease in the prevalence of malignancies and a recent increase in cases that are attributable to thyroid surgery. This study determined the contemporary etiology of unilateral and bilateral VFP, other than primary laryngeal and hypopharyngeal cancers.…”

Vocal Cord Paralysis: Pathophysiology, Etiologies, and Evaluation

“…69 A recent prospective study of 53 patient with vocal cord paralysis demonstrated cancer as the cause after CT evaluation in 27 (51%) with 15 patients (28%) having vocal cord paralysis as their primary presenting complaint. 82…”

Paraneoplastic Syndrome of Myasthenia Gravis Presenting as Isolated Vocal Cord Paralysis in a Patient with Breast Cancer: Case Report and Literature Review

“…Malignant causes of direct VCP are also uncommon. Breast cancer causing vocal cord paralysis has rarely been reported due to actual metastatic deposits of tumor in the vocal cord or compressing the larynx or laryngeal nerves (6). A prospective evaluation of vocal cord paralysis found left sided non-small cell lung cancer to be the most common culprit.…”