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Glottic Insufficiency: Vocal Fold Paralysis, Paresis, and Atrophy

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Operative Techniques in Laryngology

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Abstract

  • Glottic insufficiency is one of the most common contributing factors in patients who present with dysphonia and is one of the easiest findings to overlook in clinical evaluation.

  • The most common causes of symptomatic glottic insufficiency are unilateral vocal fold paralysis, unilateral or bilateral vocal fold paresis, and vocal fold atrophy associated with aging.

  • Treatment of “early” unilateral vocal fold paralysis is individualized for each patient and takes into account the patient’s risk of aspiration, vocal demands, nature of neural injury, and LEMG findings.

  • Videostroboscopy plays a pivotal role in the evaluation of suspected vocal fold paresis. Subtle clues include:

    • Mild bowing of the vocal fold(s)

    • Incomplete glottic closure

    • Prolonged “open phase” of the vibratory cycle (see Chapter 2—“Principles of Clinical Evaluation for Voice Disorders”)

    • Increased vibratory amplitude in the paretic vocal fold

    • Chasing/asynchronous mucosal wave propagation and unilateral false vocal fold compression

Reduced vocal fold motion (speed and/or range of motion) with adduction or abduction

Decreased vocal fold bulk with a related capacious ventricle

  • Loss of vocal projection and voice fatigue with extended use are classic symptoms of vocal fold paresis and can easily be missed in the history.

  • All unexplained vocal fold paralyses should be investigated with imaging studies (CT or MRI), tracing the entire vagus nerve/RLN from the skull base to the upper chest.

  • Parkinson’s disease (PD) often presents with dysphonia and vocal fold bowing and can be confused with presbylaryngis. The clinical distinction is important, as PD patients are generally poor surgical candidates and should instead undergo voice therapy as the primary treatment for their dysphonia.

Commentary by Lucian Sulica, MD

Commentary by Lucian Sulica MD. Department of Otolaryngology—Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA

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Bibliography

  • Badia PI, Hillel AT, Shah MD, Johns MM III, Klein AM. Computed tomography has low yield in the evaluation of idiopathic unilateral true vocal fold paresis. Laryngoscope. 2013;123(1):204–7.

    Article  PubMed  Google Scholar 

  • Benninger MS, Crumley RL, Ford CN, et al. Evaluation and treatment of the unilateral paralyzed vocal fold. Otolaryngol Head Neck Surg. 1994;111:497–508.

    Article  CAS  PubMed  Google Scholar 

  • Blitzer A, Brin MF, Sasaki CT, et al. Neurologic disorders of the larynx. Stuttgart: Thieme; 1992.

    Google Scholar 

  • Blitzer A, Jahn AF, Keider A. Semon’s law revisited: an electromyographic analysis of laryngeal synkinesis. Ann Otol Rhinol Laryngol. 1996;105:764–9.

    Article  CAS  PubMed  Google Scholar 

  • Carroll TL, Rosen CA. Trial vocal fold injection. J Voice. 2010;24(4):494–8.

    Article  PubMed  Google Scholar 

  • Crawley BK, Sulica L. Vocal fold paralysis as a delayed consequence of neck and chest radiotherapy. Otolaryngol Head Neck Surg. 2015;153(2):239–43.

    Article  PubMed  Google Scholar 

  • D’Alatri L, Galla S, Rigante M, Antonelli O, Buldrini S, Marchese MR. Role of early voice therapy in patients affected by unilateral vocal fold paralysis. J Laryngol Otol. 2008;122(9):936–41.

    Article  PubMed  Google Scholar 

  • Flowers RH, Kernodle DS. Vagal mononeuritis caused by herpes simplex virus: association with unilateral vocal cord paralysis. Am J Med. 1990;88:686–8.

    Article  PubMed  Google Scholar 

  • Hojjat H, Svider PF, Folbe AJ, Raza SN, Carron MA, Shkoukani MA, et al. Cost-effectiveness of routine computed tomography in the evaluation of idiopathic unilateral vocal fold paralysis. Laryngoscope. 2017;127(2):440–4.

    Article  PubMed  Google Scholar 

  • Ingle JW, Young VN, Smith LJ, Munin MC, Rosen CA. Prospective evaluation of the clinical utility of laryngeal electromyography. Laryngoscope. 2014;124(12):2745–9.

    Article  PubMed  Google Scholar 

  • Munin MC, Heman-Ackah YD, Rosen CA, Sulica L, Maronian N, Mandel S, et al. Consensus statement: using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis. Muscle Nerve. 2016;53(6):850–5.

    Article  PubMed  Google Scholar 

  • Netterville JL, Koriwchak MJ, Winkle M, et al. Vocal fold paralysis following the anterior approach to the cervical spine. Ann Otol Rhinol Laryngol. 1996;105:85–91.

    Article  CAS  PubMed  Google Scholar 

  • Prendes BL, Yung KC, Likhterov I, Schneider SL, Al-Jurf SA, Courey MS. Long-term effects of injection laryngoplasty with a temporary agent on voice quality and vocal fold position. Laryngoscope. 2012;122(10):2227–33.

    Article  PubMed  Google Scholar 

  • Roehm PC, Rosen C. Dynamic voice assessment using flexible laryngoscopy--how I do it: a targeted problem and its solution. Am J Otolaryngol. 2004;25(2):138–41.

    Article  PubMed  Google Scholar 

  • Rosen CA, Mau T, Remacle M, Hess M, Eckel HE, Young VN, et al. Nomenclature proposal to describe vocal fold motion impairment. Eur Arch Otorhinolaryngol. 2016;273(8):1995–9.

    Article  PubMed  Google Scholar 

  • Rosenthal LH, Benninger MS, Deeb RH. Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope. 2007;117(10):1864–70.

    Article  PubMed  Google Scholar 

  • Simpson CB, May LS, Green JK, Eller RL, Jackson CE. Vibratory asymmetry in mobile vocal folds: is it predictive of vocal fold paresis? Ann Otol Rhinol Laryngol. 2011;120(4):239–42.

    Article  PubMed  Google Scholar 

  • Smith LJ, Rosen CA, Niyonkuru C, Munin MC. Quantitative electromyography improves prediction in vocal fold paralysis. Laryngoscope. 2012;122(4):854–9.

    Article  PubMed  Google Scholar 

  • Terris DJ, Arnstein DP, Nguyen HH. Contemporary evaluation of unilateral vocal cord paralysis. Otolaryngol Head Neck Surg. 1992;107:84–90.

    Article  CAS  PubMed  Google Scholar 

  • Woodson GE. Configuration of the glottis in laryngeal paralysis. I: Clinical study. Laryngoscope. 1993;103:1227–34.

    Article  CAS  PubMed  Google Scholar 

  • Wu AP, Sulica L. Diagnosis of vocal fold paresis: current opinion and practice. Laryngoscope. 2015;125(4):904–8.

    Article  PubMed  Google Scholar 

  • Young VN, Gartner-Schmidt J, Rosen CA. Comparison of voice outcomes after trial and long-term vocal fold augmentation in vocal fold atrophy. Laryngoscope. 2015;125(4):934–40.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    C. Blake Simpson

  2. UCSF Voice & Swallowing Center, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA

    Clark A. Rosen

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  1. C. Blake Simpson
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Correspondence to Clark A. Rosen .

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Simpson, C.B., Rosen, C.A. (2024). Glottic Insufficiency: Vocal Fold Paralysis, Paresis, and Atrophy. In: Operative Techniques in Laryngology. Springer, Cham. https://doi.org/10.1007/978-3-031-34354-4_5

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  • DOI: https://doi.org/10.1007/978-3-031-34354-4_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-34353-7

  • Online ISBN: 978-3-031-34354-4

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