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Vocal Cord Paralysis Evaluation and Etiology

last modified on: Mon, 01/15/2018 - 08:28

Vocal Cord Paralysis Evaluation and Etiology

see also: Vocal Fold Paralysis (Vocal Cord Paralysis) Etiologies

return to: Unilateral Laryngeal Paralysis or Vocal Cord Paralysis

 

  1. Etiology
    1. Population based study from Germany (Djugai 2014)
      1. 1430 patients with vocal cord paralysis (VCP)  - both uni- and bi-lateral treated in Thuringia, Germany 2005-2010
        1. 42% Iatrogenic / 27% Neoplastic Infiltration
      2. 13% received surgical treatment; 31% of these needed more than on surgery; surgical complication rate of 31%
  2. Evaluation
    1. Prospective study of 86 patients with unexplained vocal cord paralysis (VCP)  (El Badawey 2008) 
      1. Conclude: CT neck+/-chest important role in evaluation of VCP patients
        1. CT: 3 mm slice thickness in neck; 5 mm slice thickness in chest
        2. Right VCP: CT from skull base to lung apex
        3. Left VCP: CT from skull base to diaphragm
      2. 51/86 left vocal cord paralysis; 31/86 right vocal cord paralysis; 4 with bilateral vocal cord paralysis
      3. 24/86 had relevant CT abnormalities - most commonly bronchogenic carcinoma
      4. 62/86 with negative CT
        1. 30/62 (48%) had satisfactory voice recovery after 6 months
        2. 15/62 (24%) had full recovery of vocal cord movement within 9 months
        3. Panendoscopy done in 20 patients - with no benefit seen in any in changing treatment plan or dx
    2. Laboratory evaluation (blood study) is frequently not performed but does have advocates
      1. White et al  (2017) employed a battery of serologic studies in a large series of patients with idiopathic unilateral laryngeal paralysis and related that their experience justified continued use of the battery listed below'with the possible exceptions of antithyroglobulin antiboides, ANA, and RF" 
        1. Laboratory tests collected: Lyme titer, erythrocyte sedimentation rate, fasting BG, thyroid-stimulating hormone (TSH), ANA, RF, fluorescent treponemal antibody absorption (FTA-ABS), antithyroid peroxidase antibody, antithyroglobulin antibody, white blood cell (WBC) count, and hemoglobin (Hg). 
      2. Merati (2006) through a survey of ABEA members identified the majority of respondents (80%) felt that serum testing for idiopathic laryngeal paralysis was only "occasionally" or "never" necessary. The most common tests were rheumatoid factor (38%), Lyme titer (36%), erythrocyte sedimentation rate (34%), and antinuclear antibody (33%). 
        1. This same survey identified the majority (72%) felt that computed tomography (CT) was "always" or "often" necessary

References:

El Badawey MR, Punekar S, and Zammit-Maempel I: Prospective Study to Assess Vocal Crod Palsy Investigations Otolaryngology - Head and Neck Surgery Vol 138, Issue 6, June 2008, Pages 788-790

Djugai S, Boeger D, Buentzel J, Esser D, Hoffmann K, Jecker P, Mueller A, Radtke G, Bohne S, Finkensieper M, Volk GF, Guntianas-Lichius O: Chronic vocal cord palsy in Thurigngia, German: a population based study on epidemiology and outcome.  Eur Arch Otorhinolaryngol 2014 Vol 271, Issue 2, Pages 32935

White M1, Meenan K1, Patel T2, Jaworek A1, Sataloff RT3. Laboratory Evaluation of Vocal Fold Paralysis and Paresis.J Voice. 2017 Mar;31(2):168-174. doi: 10.1016/j.jvoice.2016.07.022. Epub 2016 Oct 21.
Merati AL, Halum SL, Smith TL. Diagnostic testing for vocal fold paralysis: survey of practice and evidence-based medicine review. Laryngoscope. 2006;116:1539–1552