Unilateral laryngeal paralysis

Abstract

Phoniatric rehabilitation is mainly aimed at restoring satisfactory phonation. Voice quality depends on the capacity of intact vocal cords to compensate the deficiency involved, as well as on automatism of phonation. The study included 50 patients. All subjects underwent history taking, reported symptoms that urged them to visit a phoniatrician; they were submitted to a clinical otorhinolaryngologic and phoniatric examinations, voice assessment by subjective acoustic analysis, spectral analysis by digital sonography and laryngostroboscopy. All patients underwent Seeman's method of laryngeal compression. The examined group of 50 subjects included 17 males (34%) and 33 females (66%). Vocal cord palsy was most often due to neck surgery (strumectomy) in 19 patients (38%), followed by an idiopathic palsy involved in 12 patients (24%). Disocclusion of 1-2 mm and 3-3 mm was registered in 54% and 24% patients, respectively. After treatment total occlusion was established in 20% of patients, while disocclusion of up to 1 mm, 1-2 mm or 2-3 mm persisted in 36%, 20% and 2% of patients, respectively. T-test revealed a statistically significant difference in glottic incompetence prior to and after treatment (p < 0.01). After treatment, using Seeman's method of digital compression of the larynx, 48% of patients regained satisfactory speech and voice clarity and 50% of them still presented mild dysphonia. Moderate dysphonia was registered in 2%, but none of the patients had severe dysphonia. Central laryngeal palsies made 4% of our examined group, while according to the literature they make 1.2-8.7% of all laryngeal palsies. In majority of cases, paralysis of the recurrent laryngeal nerve was due to neck surgery (38%), but literature reports indicate that iatrogenic palsies are mostly due to operation of the thyroid. The well known fact that the left recurrent nerve is more frequently paralysed, has been confirmed in our study as well. Accurate and efficient treatment of unilateral laryngeal palsies requires team work. Phoniatric rehabilitation of the disorder using Seeman's method has proved efficient in diminishing the glottic incompetence and dysphonia. Patients who fail to respond to phoniatric rehabilitation should be treated using other therapeutic modalities.