Unilateral Vocal Cord Paralysis Research Articles

Intraoperative Monitoring and Preservation of Anatomic Integrity of Palsied Recurrent Laryngeal Nerve is Extremely Meaningful During Redo Thyroid Surgery.

Redo thyroid surgery on patients with unilateral recurrent laryngeal nerve (RLN) palsy certainly poses a great surgical challenge. We present a case of a patient with unilateral vocal cord (VC) palsy who underwent redo thyroid surgery under intraoperative neuromonitoring. The patient's normal speaking voice was maintained after the primary surgery, even though preoperative laryngoscopy showed an immobile right VC with a normal structure. During reoperation, surgical exploration revealed the anatomical integrity of palsied RLN with extralaryngeal terminal bifurcation. The electrophysiological stimulation of the vagus nerve and palsied RLN generated wave amplitudes (V1: 242, R1: 347, R2: 352 and V2: 152 µV). Despite positive amplitudes, postoperative laryngoscopy confirmed RLN palsy and corresponding VC paralysis but preserved the structure of the immobile VC. Even palsied RLN should be monitored during redo surgery. A positive signal delineates at least partial neural transmission despite VC palsy. The preservation of anatomical integrity of palsied RLN for eventual partial conductivity may be vital in preserving the normal structure of VC and maintaining the patient's voice despite its immobility. Key Words: Surgery, Redo thyroidectomy, Recurrent laryngeal nerve injury, Vocal cord palsy.

A Case of Unilateral Vocal Cord Palsy due to Bakelite Exposure

A Case of Unilateral Vocal Cord Palsy due to Bakelite Exposure

Should Thyroid Lobectomy Be Performed as a Day-Case Procedure? A Single-Centre Retrospective Audit.

Introduction The British Association of Endocrine and Thyroid Surgeons (BAETS) published guidance in 2012 advising against day-case thyroid lobectomy due to the unpredictable risk of post-operative haematoma. Due to the increasing pressures the National Health Service (NHS) faces, a position statement was released by BAETS in 2020 highlighting their support of day-case thyroid lobectomy in specific low-risk cases with the introduction of appropriate local protocols. Objective We aimed to assess post-operative complications of thyroid lobectomy at University Hospitals Bristol and Weston NHS Trust (UHBW), a tertiary centre for Otolaryngology, to consider the feasibility and safety of day-case surgery in our unit. Methods We conducted a retrospective audit of 140 elective thyroid lobectomy cases identified in the period of January 2017 to December 2018 at UHBW. Inclusion criteria included no previous thyroid surgery or major head and neck surgery, elective thyroid lobectomy procedure only, and surgery performed at UHBW by otolaryngology or maxillofacial teams. Exclusion criteria included emergency hemithyroidectomy; hemithyroidectomy as part of another procedure; and completion thyroidectomy. Results A total of 140 elective thyroid lobectomy procedures were performed between January 2017 and December 2018. Of them, 125 cases met inclusion criteria, and 15 cases were excluded: two emergency hemithyroidectomy, three incorrect coding, four hemithyroidectomy as part of another head and neck procedure, and six completion thyroidectomy. Mean age was 51.9 years (range: 20-88 years), with 30 (24.0%) male cases and 95 (76.0%) female cases. Mean in-patient stay was 1.4 days (range: 0-19 days), and mean hours in hospital were 34 hours. Two (1.6%) cases were discharged on the same day of their operation. Post-operative complications included five (4%) cases of post-operative haematoma, four (3.2%) cases of unilateral vocal cord palsy, one (0.8%) case of pneumonia, and three (2.4%) cases of wound infections. From those cases that developed post-operative haematoma, 80% (n=4/5) developed less than 24 hours after the procedure. One (20%) case of post-operative haematoma developed on day 6 after their procedure and required readmission for re-operation. Conclusion The unpredictable nature of post-operative haematoma poses a significant risk to patients and medicolegal implications. Our findings suggest that there were no predictable risk factors amongst our patient cohort and therefore day-case thyroid lobectomy should be avoided. Further research is required to identify low-risk patients who could benefit from day-case surgery.

Extralaryngeal causes of unilateral vocal cord paralysis: Aetiology and prognosis

Introduction and methodologyUnilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases of the thorax, neck, skull, or systemic disease. The objective is to study the extralaryngeal aetiology of unilateral vocal cord paralysis, its prognosis, and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT ± evaluation by Neurology with brain MRI to establish the aetiology and were followed-up for at least 1 year. ResultsThe most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumour (24.1%). Idiopathic paralysis was the cause in 15.5%. An association was obtained between sex and aetiology (P < .01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumour and idiopathic aetiology predominated in elderly patients; while surgical aetiology predominated in younger patients (P < .01). A total of 18.1% recovered vocal cord mobility. The female sex was related to recovery (P < .01). Tobacco and malignant aetiology were related to persistence (P < .01). ConclusionsThe first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause the condition, in many cases involving a diagnosis of malignant tumours. Recovery is more frequent in female patients, non-smokers and with benign pathology.

Clinico etiological spectrum of unilateral vocal cord paralysis - A prospective study

Unilateral vocal cord palsy is relatively common in Otorhinolaryngology clinics. Due to reasons more than one, the exact incidence of the etiology behind unilateral vocal cord palsy has remained a mystery difficult to unfold. The present study was undertaken to determine the clinical presentation and etiopathology of unilateral vocal cord paralysis. The present study was a prospective study undertaken in the Department of Otorhinolaryngology at KIMS Hospital, Secunderabad from June 2018 to May 2020 after the approval of the Ethical Committee among 50 adult patients with a confirmed diagnosis of Unilateral Vocal cord palsy. Patients with the fixity of the vocal cord, laryngeal malignancies, and bilateral Vocal cord palsy/paresis were excluded from the study. A thorough history and ENT, head &amp; neck examination followed by a radiological examination to make an etiological diagnosis of Vocal cord palsy were done. For patients with no cause found, a CT/ MRI imaging was done before labeling them as idiopathic. Most of the patients presented in the 4th and 5th decades of life, with male predominance. The most common presenting symptom was hoarseness of voice (80%) and Left-side vocal cord palsy (56%) is more common. The most common cause was idiopathic (34%) followed by post-surgical trauma, neoplastic, central cause, cardiac, granulomatous disorders, and neurological and post-intubation trauma respectively. In conclusion, our study shows thorough evaluation and investigation of cases with unilateral vocal cord palsy unveils interesting and sometimes rare and probably life-threatening underlying pathologies, that could be managed appropriately.

An Analysis of Postoperative Complications in Medialization Thyroplasty: NSQIP Data

Introduction: Medialization thyroplasty is a procedure indicated for treatment of impaired vocal fold movement. The purpose of this study was to identify variables associated with length of hospital stay (LOS), reoperation, and readmission in patients who underwent a medialization thyroplasty procedure for unilateral vocal cord paralysis. Methods: Adults who underwent unilateral medialization thyroplasty were identified using the 2017 to 2019 NSQIP databases via Current Procedural Terminology code 31591. Data collected included patient demographics, comorbidities, preoperative labs, American Society of Anesthesiologists classification, inpatient status, operative length, and complications. Univariate and multivariate logistic regression were used to analyze effects on total LOS, reoperation, and readmission. Results: 320 patients were identified, with a mean age of 61 years (95% Cl 59.4–62.7) and a female-to-male ratio of 1.1:1. Forty-two (13.1%) patients reported dyspnea as a preoperative symptom. Seven patients (2.2%) reported postoperative complications, 2 with multiple complications: 2 surgical site infections, 2 pneumonias, 2 unplanned intubations, 2 myocardial infarctions, 1 septic shock, 1 cardiac arrest, 1 ventilator use (>48 h), and 1 acute renal failure. Fifty-one (15.9%) were inpatient procedures, with a mean LOS of 1.43 days (95% CI 0.92–1.94). Preoperative functional status and bilirubin were significantly associated with longer LOS (p < 0.001). There were 6 (1.9%) readmissions and 2 (0.6%) reoperations. In univariate analysis, dyspnea varied with reoperation which is important to note in this patient population with glottic insufficiency. Conclusion: Medialization thyroplasty is a procedure with a low risk of mortality. However, preexisting patient comorbidities are associated with an increased risk of postoperative complications and an increased length of stay.

Laryngeal Framework Surgery for Unilateral Vocal Fold Paralysis

The laryngeal framework surgery (LFS) is an operation to correct the position and tension of the vocal cords by changing the laryngeal cartilage and muscles. LFS such as type 1 thyroplasty, arytenoid adduction, and arytenopexy is performed to improve the voice of patients with unilateral vocal cord paralysis. It is known that the voice improvement effect of LFS in patients with unilateral vocal cord paralysis is excellent and lasts for a long time. LFS can also be operated under local anesthesia. Complications are not common, however, severe complications like airway obstruction could occur after the operation. Recently, several other attempts to modify the traditional surgical method have been reported. This review is intended to be helpful in understanding the characteristics and changes in laryngeal framework surgery.

Injection Laryngoplasty with Hyaluronic Acid: A Study to Analyze the Quality and Longevity of Voice Improvement in Unilateral Vocal Cord Palsy

Injection Laryngoplasty with Hyaluronic Acid: A Study to Analyze the Quality and Longevity of Voice Improvement in Unilateral Vocal Cord Palsy

An 18-Year-Old Female Experiences Unilateral Vocal Cord Paralysis during Mild COVID-19 Infection

The COVID-19 pandemic has shown with certainty that SARS-CoV-2 can cause a variety of clinical findings, with some of the most notable being lasting chemosensory changes. Severe infections with SARS-CoV-2 can also lead to a variety of complications. For example, vocal cord paralysis can be caused by trauma sustained during intubation, which is a necessary procedure for many severe cases. Rarely, SARS-CoV-2 related vocal cord paralysis has occurred outside the context of intubation. These cases contribute to an emerging assortment of evidence supporting the neuropathic capacity of SARS-CoV-2. This report documents a case of COVID-19 related vocal cord paralysis in an 18-year-old female. The patient had a significant history of muscle tension dysphonia, chronic laryngitis, and vocal cord nodules. The patient developed vocal cord paralysis concurrently with the onset of mild viral symptoms and was never intubated or hospitalized. Based on the onset of symptoms and other causes being excluded with CT, a diagnosis of COVID-19-related vocal cord paralysis was performed.

A Comparative Study on the Outcomes of Early and Delayed Type-1 Thyroplasty Following Unilateral Vocal Cord Palsy

Unilateral Vocal cord palsy typically presents with dysphonia, shortness of breath and swallowing difficulty. It can be iatrogenic, idiopathic or may occur secondary to damage to recurrent laryngeal nerve following trauma, impinging mass lesions, neurological disorders or neuro-musculoskeletal diseases, or infectious in aetiology. To study and compare the effects of Type I Thyroplasty depending on the time of presentation, that is, early and delayed presentation. Ambispective Study Design. Our study included 32 patients who presented to our Institution with history of dysphonia, diagnosed with unilateral vocal cord palsy. Depending on the duration of symptoms on presentation, patients were categorised into 2 groups, which is early subgroup who presented within 1 year of symptom onset, 21 patients and delayed subgroup who presented after 1 year of symptom onset, 11 patients. Complete preoperative evaluation including perceptual analysis of voice quality, acoustic measures of voice quality, Aerodynamic measures of voice quality, quality of life measure, tele laryngoscopy was done. All patients underwent Type I Thyroplasty and were followed up at 2 weeks, 1 months, 3 months and 6 months, with follow up criteria including perceptual analysis of voice, MPT and VHI-10. Out of 32 patients, Male to female ratio was 26 : 6, with mean age of presentation being 47 years. The laterality of the palsy was R: L → 4: 28. When compared to the Delayed subgroup, early Subgroup had significant improvement in outcomes with respect to GRBAS Scale, VHI-10 and MPT. Keywords: Unilateral vocal cord palsy, Early &amp; Delayed

Effect of injection laryngoplasty material on outcomes in pediatric vocal fold paralysis.

BackgroundWhile injection laryngoplasty is becoming increasingly common in children, there has not been clearly established guidelines for the choice of injection material. This study evaluates for variability in post-surgical outcomes between different materials used for injection laryngoplasty in the treatment of pediatric unilateral vocal cord paralysis.MethodsIn this cohort study, a retrospective chart review was performed for all patients undergoing injection laryngoplasty for unilateral vocal cord paralysis at our tertiary-care children’s hospital between January 2010 and December 2019. Patients with vocal cord paresis or bilateral vocal cord paralysis were excluded from this study. Demographics, pre- and post-injection clinic visits, and operative reports were reviewed to compare outcomes between injection materials, including the number of injections required, inter-surgical interval, and rate of vocal improvement.ResultsForty-four patients were included in the analysis. Half of the patients were female, and half were male. A total of 97 injections were observed, with 32 patients receiving multiple injections. The mean age at first injection was 7 years. The most common causes of vocal fold paralysis were iatrogenic (n=21, 48%) and idiopathic (n=9, 20%). Thirty-nine percent (n=17) had a history of cardiac surgery. Forty-five percent of injections used Radiesse® voice/Prolaryn® plus, 35% used Radiesse®/Prolaryn® voice Gel, and 20% used Cymetra™. The material used was not associated with a difference in post-operative outcomes, including number of injections, (P=0.10; 0.29), inter-surgical interval (P=0.27; 0.29), or rate of voice improvement (P=0.86; 0.36).ConclusionsNeither material choice nor demographic factors were associated with a difference in outcomes following injection laryngoplasty or a change in the inter-surgical interval. Further research is needed to develop standardized protocols for injection laryngoplasty in this population.

Varicella Zoster Meningitis Presenting as Unilateral Vocal Cord Paralysis (P5-9.001)

Varicella Zoster Meningitis Presenting as Unilateral Vocal Cord Paralysis (P5-9.001)

Selective laryngoscopy before thyroidectomy: a risk assessment

Patients presenting for thyroidectomy may have an unrecognized pre-existing vocal cord palsy (VCP). This raises the danger of bilateral VCP if a patient sustains an injury to the RLN on the sole functioning side. Part of the rationale for routine preoperative laryngoscopy is to eliminate such a risk. This paper endeavours to quantify the relevant potential risk. Patients who underwent laryngoscopy prior to thyroid or parathyroid surgery in an endocrine surgical unit over a 5 year period were identified. Literature review revealed four papers in which VCP prevalence in patients without risk factors was reported. Using our data, combined with that of these other authors, the background rate of pre-existing VCP was ascertained, and the subsequent risk of bilateral VCP estimated. Of our 632 patients who underwent preoperative laryngoscopy, there were four patients (0.63%) who were found to have a unilateral VCP, but all had voice symptoms or previous neck surgery. When patients with these risk factors are excluded, our data combined with the published data provides a pre-existing VCP rate of 0.2%. Calculations estimate that if preoperative laryngoscopy is omitted in patients with no risk factors, the risk of bilateral VCP, due to the nerve on the sole functioning side being injured, would be between 1/50000 and 1/150000, depending on an individual surgeon's level of experience. Selective use of laryngoscopy prior to thyroidectomy would result in an acceptably low statistical risk of bilateral VCP. Routine laryngoscopy for all patients is not necessary.

Long-Term Treatment Outcome of Type 1 Thyroplasty Using Novel Titanium Medialization Laryngoplasty Implant Combined with Arytenoid Adduction for Unilateral Vocal Cord Paralysis

Long-Term Treatment Outcome of Type 1 Thyroplasty Using Novel Titanium Medialization Laryngoplasty Implant Combined with Arytenoid Adduction for Unilateral Vocal Cord Paralysis

Revisiting CT Signs of Unilateral Vocal Fold Paralysis: A Single, Blinded Study.

Several CT findings are thought to be indicative of vocal cord paralysis; however, these signs have never been validated in a blinded fashion. This study attempts to compare and validate these signs and determine their accuracy in predicting vocal cord paralysis. A retrospective chart review was performed, and CT scans from patients with known unilateral vocal cord paralysis and known normal vocal cord movement were reviewed by 3 radiologists who were blinded to the status of the patients' laryngeal function. The scans were reviewed and scored for 8 accepted signs of vocal cord paralysis as well as for predicting a final diagnostic conclusion. Statistical analysis using odds ratios for signs and the Fleiss κ for criterion agreement among the radiologists was performed for diagnostic accuracy. The presence of medial displacement of the posterior ipsilateral vocal fold margin and ipsilateral laryngeal ventricular dilation yielded the greatest positive predictive value. Other signs demonstrated high specificity, but interrater discrepancy was greater than expected and diminished the reliability of these signs in predicting vocal cord paralysis. Overall, sensitivity and negative predictive values were low. Predicting vocal cord paralysis on the basis of CT findings is not as accurate or straightforward in prospectively predicting vocal cord paralysis as implied in prior studies.

DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS-MEDIATED DYSPHAGIA

A 62-year-old man who presented with recurrent aspiration pneumonia and weight loss was diagnosed with oropharyngeal dysphagia due to unilateral vocal cord paralysis. Imaging of the neck by CT as well as ancillary tests have revealed diffuse idiopathic skeletal hyperostosis ('DISH') as the cause, mediated by pressure of an osteophyte on the recurrent laryngeal nerve. With the ageing of the populations clinicians may increasingly encounter diffuse idiopathic skeletal hyperostosis and should be aware of the syndrome and its unusual complications.

Laryngeal Dysfunction in Acute Organophosphorus and Carbamate Poisoning.

ABSTRACTBackgroundOrganophosphorus (OP) and carbamate pesticides are widely used for crop protection. We describe the spectrum of laryngeal abnormalities in patients admitted to the intensive care unit (ICU) with acute OP and carbamate poisoning as there is limited information on it.Materials and methodsConsecutive patients admitted to the ICU with acute OP and carbamate poisoning over 20 months (December 2014–July 2016) were recruited. Patients were followed up post-discharge if they had undergone tracheostomy or developed hoarseness of voice or stridor following extubation. Asymptomatic individuals who consented underwent laryngoscopy after ICU discharge. The primary outcome was the development of laryngeal dysfunction. Other outcomes included length of stay, need for ventilation, mortality, tracheostomy, and time to decannulation of tracheostomy.ResultsOf the 136 patients recruited, 71 (52%) underwent laryngoscopy. The overall mortality rate was 9.6%. Of the 71 patients who underwent laryngoscopy, 18 had abnormal findings, which included unilateral or bilateral vocal cord paresis or palsy (n = 14) and/or aspiration (n = 9), subglottic stenosis (n = 1), tracheal stenosis (n = 1), or arytenoid granuloma (n = 1). Laryngeal dysfunction was associated with the ingestion of a dimethyl OP compound (p = 0.04) and quantum consumed (p <0.001). Patients with laryngeal dysfunction had significantly (p = 0.004) longer hospital stay (19.1 ± 10.7 vs 11.8 ± 8.3 days).ConclusionLaryngeal dysfunction is not uncommon in OP and carbamate poisoning and is associated with the ingestion of larger quantity of a dimethyl OP compound and longer hospital stay. Otorhinolaryngologists could be involved early to help identify these abnormalities and initiate an appropriate treatment to ensure a functional voice and good airway.How to cite this articleMani GS, Mathews SS, Victor P, Peter JV, Yadav B, Albert RRA. Laryngeal Dysfunction in Acute Organophosphorus and Carbamate Poisoning. Indian J Crit Care Med 2022;26(2):167–173.

Quantitative Measurement of Dysphonia Severity in Patients With Stroke With Unilateral Vocal Cord Palsy.

Unilateral vocal cord palsy (UVCP) is frequently observed in patients with stroke. This study aimed to evaluate the association between objective dysphonia severity and the classification of UVCP in patients with stroke by objectively and quantitatively measuring their phonetic function. We recruited patients with UVCP diagnosed using laryngoscopy after stroke. Subgroups were divided according to UVCP type, and the dysphonia severity index (DSI) and maximum phonation time (MPT) were measured to objectively evaluate dysphonia. The DSI and MPT were compared between subgroups using analysis of variance with Tukey's honest significant difference post hoc test. In total, 103 patients with stroke and UVCP were recruited. We found that a higher UVCP severity possibly had to do with lower DSI and MPT values. We objectively confirmed that phonetic function was worse in patients with stroke with higher UVCP severity, and the DSI and MPT tests can be helpful in determining the severity and need for additional evaluation.

DESIGNING AND 3D PRINTED PLA BASED IMPLANT USED IN TREATMENT FOR UNILATERAL VOCAL CORD PARALYSIS

Vocal cord paralysis (VCP) is considered as a closure of glottal cavity during phonation. Vibration impairment in the vocal mucosa to loss of voice is as a result of the glottic space not closing. Many implant biomaterials are used for VCP. These implants, which can be applied to restore the cord function of the paralyzed cord and to improve the sound quality, are applied in Medialization thyroplasty (MT) type 1 surgeon. The aim of this study is to produce customizable poly (lactic-acid) (PLA) based vocal cord (VC), also called as vocal fold, implant by using 3D printer and compare this implant with other biomaterials. This VC 3D PLA implant (VC3DPLAI) biomaterial can be specially designed and manufactured for the individual.

A Review on Vocal Cord Palsy: Complications and Management

Vocal cord paralysis is a multifaceted problem that affects people of all ages and is initially diagnosed by various healthcare providers. It is a common condition that occurs due to the obstruction of nerve impulses from the brain to the voice box. It ranges from slight hoarseness to fatal, life-threatening complications. To get to the exact diagnosis, determining the etiology of paralysis is essential. For restoration of normal function, accurate diagnosis has proven to be helpful. Vocal cord paralysis (VCP) is a. reasonably common condition caused by a vagus nerve or its recurrent laryngeal nerve branch disease process. The nerve’s longer length causes increased vulnerability. Peripheral lesions to the vagus are responsible for 90% of VCP (Vocal cord paralysis). Etiology includes scarring due to intubation or inflammatory disorders, iatrogenic causes like surgical traumas, malignancy, CNS pathologies like stroke, CNS tumors, and systemic diseases like ALS, Guillain barre syndrome. Vocal cord paralysis can cause consequences such as a weak cough, trouble swallowing, dysphagia, stridor, hoarseness, aspiration risk, granuloma formation, airway blockage, and a lower quality of life. Various treatment modalities like tracheostomy, usage of botulinum toxin, adenoidectomy, cordotomy, reinnervation, and gene therapy are used. For this narrative review, a literature search was undertaken using "unilateral and bilateral vocal cord palsy" and "dysphagia" in the Pubmed, Medline, and Embase databases. Bilateral vocal cord paralysis is a problematic and distressing condition that affects both adults and children. Surgical procedures such as tracheostomy, adenoidectomy, cordotomy, and laryngeal reinnervation have been used to treat this condition successfully. Treatment modalities should be individualized according to the patient's clinical features and physician's expertise.