Predictive value of videolaryngoscopy and history in bilateral vocal fold immobility

Abstract

Objectives: Differentiating bilateral vocal fold paralysis (BVFP) from posterior glottic stenosis (PGS) is a challenging dilemma. This study explores whether videolaryngoscopic findings and/or history help predict the diagnosis in patients with bilateral vocal fold immobility. Methods: Medical records search from 1995 to 2003 for BVFP and PGS patients. Age, diagnosis, etiology, symptoms, physical exam findings, and outcome were obtained. Two senior laryngologists reviewed videolaryngoscopic examinations in a blinded fashion. Associations between videolaryngoscopic findings, history, and diagnosis were evaluated with univariate and multivariate analyses. Results: Sixty-one patients, 29 BVFP and 32 PGS, were identified with a mean age of 49 ± 18 years. Scarring occurred in 69% of PGS and 4% of BVFP patients ( P ≤ 0.001, Chi-Square). An abnormal posterior commissure and/or arytenoids occurred more commonly in PGS patients, 38%, than BVFP patients, 0% ( P ≤ 0.001, Chi-Square). Abnormalities along the membranous vocal fold were not associated with the diagnosis ( P > 0.05, Chi-Square). Using these findings without historical information, the laryngologists predicted the diagnosis with 87% accuracy. BVFP patients more frequently had a history of thyroid surgery, 45%, than PGS patients, 6% ( P = 0.001, Chi-Square). Conversely, PGS patients more commonly had an intubation history, 71%, than BVFP patients, 7% ( P ≤ 0.001, Chi-Square). On multivariate analysis, glottic scarring and intubation were associated with the diagnosis ( P < 0.02, multiple logistic regression). Conclusions: Videolaryngoscopic findings and history may help determine the diagnosis in bilateral vocal fold immobility patients and may be a useful adjunct in managing this patient population.