Laryngoscopy in Bilateral Vocal Fold Immobility: Can You Make a Diagnosis?

Abstract

This study explores whether videoendoscopic findings and patient history help make the diagnosis in bilateral vocal fold immobility (BVFI). Medical records from 1995 to 2003 were searched to identify patients with posterior glottic stenosis (PGS) and bilateral vocal fold paralysis (BVFP) who also had videoendoscopic examinations. Videoendoscopic examination findings that could help differentiate PGS from BVFP were identified a priori. A weighted scoring index, based on the adjusted odds ratios of significant examination findings on multiple logistic regression, was derived. Associations between the weighted scoring index, patient history, and diagnosis were then evaluated. Twenty-six patients with BVFP and 28 patients with PGS were identified. Posterior glottic scar (weight = 2), medial arytenoid erosion with a widened posterior glottis (weight = 1), and appropriate vocal fold motion (weight = 1) were significant variables (p < or = .05, multiple logistic regression) and constituted the weighted scoring index. A weighted scoring index of > or = 2 and a history of prolonged intubation predicted PGS in 95.2% of cases. A weighted scoring index of < or = 1 and a history of neck surgery predicted BVFP in 95.0% of cases. The weighted scoring index with the patient history provides an objective tool for diagnosing BVFI.