Etiological Factors and Management of Vocal Fold Paralysis: Single Institution Study

Hassan Alassiry

doi:10.11648/j.ijo.20180401.15

Abstract

Vocal fold paralysis is a sign of underlying diseases. However, etiologies of this problem are varied and changing from center to center and need more clarification. The aim of the study is to determine the etiological factors and management options of vocal fold paralysis among patients attended to the voice clinic center at King Abdul-Aziz Medical City. The medical records of 106 patients diagnosed with vocal fold paralysis were studied retrospectively. The following variables were recorded; age, gender, occupation, smoking, surgical history, radiation history, cause and type of vocal fold paralysis, associated risks, and management. Out of the 106 cases, 58 were males and 48 females with a ratio of 1.2:1. The age of the patients ranged from 6-92 years. Surgical trauma (iatrogenic) was the leading cause of vocal fold paralysis (45.3%) followed by idiopathic (17.9%), external neck trauma (13.2), Non-laryngeal malignancy (6.6%), post upper respiratory tract infection and viral infection (5.7%), TB and TB lymphadenitis (3.8%), intubation (2.8%), neurogenic (1.8%) and thyroid mass (1.8%). Total thyroidectomy was the most common surgical etiology of vocal fold paralysis (38.8%). The most common etiology of vocal fold paralysis is surgery and most cases were total thyroidectomy. Otolaryngologists should be familiar with the etiology, incidence, evaluation, and management options of vocal fold paralysis to optimize patient care and avoid further complication. We recommend that all patients undergoing total thyroidectomy and surgeries related to the course of recurrent laryngeal nerves should have detailed voice assessment pre-and postoperatively.

Highlights

Vocal fold paralysis is caused by abnormality in the laryngeal muscles due to partial or complete interruption of nerves which innervate that muscles
Vocal fold paralysis incidence found to be increased with age, rising and peaked in the fifth and sixth decade, this finding is in accordance with literature; Yumoto et al, who found that the incidence of vocal fold paralysis in the fourth decade is rapidly raised and peaked in the sixth decade
Gandhi S et al reported that unilateral vocal fold paralysis peaked in the fourth and fifth decade. [13, 14] Vocal fold paralysis found to be not related to the occupation of the patients; this finding was emphasized by Srivastava S et al [15]

Summary

Introduction

Vocal fold paralysis is caused by abnormality in the laryngeal muscles due to partial or complete interruption of nerves which innervate that muscles. Those nerves are recurrent laryngeal nerve and superior laryngeal nerve. This disorder is caused by disruption, compression or inflammation of the nerves along its anatomic course. It can be caused by; post-surgical complication such as head, neck, thorax and cervical spine procedures. There are many studies proves that surgical trauma is the most common cause of vocal fold paralysis. Vocal fold paralysis usually present with voice changes, airway problems, swallowing problem, and aspiration. [1,2,3,4,5,6,7,8,9,10,11,12]

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