Vocal fold palsy: a re-evaluation of investigations

Abstract

ConclusionsA posterior fossa lesion is the cause of vocal cord palsy in 1-2% of cases. Despite low potential pickup rates, thorough imaging strategies such as those that currently exist for vestibular schwannoma screening avoid important missed diagnoses. We suggest updated imaging guidelines for investigating unilateral vocal cord palsy. A CT scan to include the posterior fossa may be adequate but MRI should be performed if clinical examination suggests skull base pathology or where clinical doubt remains. Further discussion is required between ENT clinicians and radiology colleagues to develop a UK national consensus for investigating vocal cord palsy. Keypoints• Unilateral vocal cord palsy is a common diagnosis in otolaryngology, with significant related morbidity. • A posterior fossa lesion is the cause of unilateral vocal cord palsy in 1-2% of cases. • Thorough clinical examination in conjunction with robust imaging strategies avoids missed diagnoses and consequent patient morbidity. • Imaging protocols vary widely, and no consensus currently exists. • The case that stimulated us to audit a case series and carry out a UK survey of current practice is presented. The results suggest that a more formal panel be set up to suggest an appropriate side-based protocol for the investigation of vocal cord palsy. Conflicts of interestNone.

Laryngeal Paralysis: Distinguishing Xth Nerve from Recurrent Nerve Paralysis Through Videoendoscopic Swallowing Study (VESS)

“…In the absence of an obvious cause such as surgical trauma, efforts are required to determine the cause of paralysis since the most common cause is neoplasm. Left vocal fold palsies are more common than those on the right and are much more likely to be due to malignant processes, especially from pulmonary or mediastinal diseases [13][14][15][16]20]. Extensive search for occult causes should be undertaken before diagnosing idiopathic paralysis.…”

“…This is reported in a range of 16-33% in unilateral vocal fold paralysis [13-16, 20, 21]. From the study of MacGregor et al [20], there is little consensus in the choice of investigations, with a number of recommended examinations being considered by ENT surgeons thought of as unhelpful, time consuming, or an unnecessary expense. In addition, no series lists the investigations according to whether recurrent or Xth nerve paralysis is impaired.…”

“…It has been previously proposed that radiological examinations should be repeated at six months and annually for two years when investigations are negative in order to detect apparent neoplasms [20]. In the only patient where no cause was identified, the negative results of the followup performed during a period of more than two years allowed elimination of dubious process.…”

A Survey on perceived speaker traits: Personality, likability, pathology, and the first challenge

“…Phonation or voice disorders are disorders where the process of phonation is disturbed (Aronson and Bless, 2009). This can range from mild issues like hoarseness (Pretorius and Milford, 2008), over persons with vocal fold paralysis (MacGregor et al, 1994), to persons with laryngeal cancer and tracheoesophageal substitute voice (Brown et al, 2003). Speech disorders (Harrison, 2010) refer to disorders where problems exist within the articulation tract.…”

“…Dysarthria counts as a sub-group of articulation disorders. An example is Parkinson's Disease, a degenerative disorder of the central nervous system where dopamine-generating cells die, which has an impact on the control of muscles (MacGregor et al, 1994). Disorders in written language and dysgraphia respectively dyslexia are also communication disorders but are not further addressed in this overview.…”