Supraglottic Function in Unilateral Vocal Fold Paralysis

Abstract

Objective: Supraglottic hyperfunction is a compensatory behavior that occurs in patients with glottic incompetency. It is pronounced in unilateral vocal fold immobility (UVFI), where false vocal folds (FVF) can obfuscate evaluation of the true vocal folds. We sought to characterize supraglottic hyperfunction patterns in post-surgical UVFI patients. Method: Videostroboscopy examinations of 10 consecutive post-surgical patients with complete UVFI diagnosed within 3 months of surgery were reviewed by 2 blinded, independent reviewers. Characteristics of supraglottic hyperfunction were scored for direction (AP or lateral) and whether laterality was asymmetric relative to UVFI (primary outcome). Kappa tests measured interrater reliability. Results: The UVFI cohort was evaluated a median of 63.5 days postsurgery. UVFI was left-sided in 6 out of 10 patients. All patients had asymmetric lateral FVF hyperfunction with predominant medial excursion by the FVF contralateral to the immobile vocal fold (kappa = 1, P < .01). AP hyperfunction occurred in 1 out of 2 of cases, with its significance less agreed upon by reviewers (kappa = 0.4, P = .09). Petiole deviation toward the immobile vocal fold occurred in 70% of cases (kappa = 1, P < .01). Conclusion: Supraglottic hyperfunction was universal in patients with UVFI. The most common pattern was 1) asymmetric lateral FVF hyperfunction with maximum medial excursion of the contralateral FVF, and 2) petiole deviation toward the side of UVFI. Understanding fiberoptic examinations of UVFI may aid our diagnostic accuracy in lesser vocal fold pareses.