Unilateral Vocal Fold Motion Impairment Research Articles

Pediatric Unilateral Vocal Fold Paralysis: Workup and Management

This paper will examine recent advances in the assessment and management of pediatric unilateral vocal fold motion impairment (VFMI). Unilateral VFMI can have a considerable impact on pediatric voice, swallowing, and pulmonary hygiene. In addition, postoperative VFMI in children undergoing congenital cardiac procedures is associated with longer lengths of stay. Laryngeal ultrasound (LUS) is an adjunctive tool that can be used to assess vocal fold mobility in patients who cannot tolerate traditional flexible nasolaryngoscopy (FNL) or for those in whom FNL is non-diagnostic. Laryngeal electromyography (LEMG) can help differentiate neuronal causes of vocal fold paralysis from mechanical cricoarytenoid joint fixation. Recent data suggests that preoperative LEMG may be used to predict voice outcomes after non-selective laryngeal reinnervation (NSLR). NSLR is a promising treatment modality for permanent vocal fold medialization in children. An emphasis on early diagnostic and prognostic techniques, such as the use of LUS and LEMG, can inform decision-making in unilateral VFMI treatment. NSLR is emerging as the preferred treatment modality for pediatric unilateral VFMI due to neuronal injury.

Ultrasound strain imaging in assessment of false vocal folds in adults: A feasibility study

PurposeThe aim of the study is to investigate the feasibility of ultrasound strain imaging (USI) in assessing magnitude and symmetry of false vocal folds (FVF) deformation as a quantitative marker for estimating FVF movement. MethodsFrom October 2016 to July 2017, we performed USI of FVF in 44 adults [33 healthy controls and 11 subjects with unilateral vocal fold motion impairment (VFMI), 17 men and 27 women, mean age 43 years]. Real time ultrasound data of FVF in different configuration (abduction and adduction) was acquired through transcutaneous anterior-mid neck. Peak to valley strain (strain magnitude of maximum to minimum) representing the largest FVF deformation was estimated using 2-D speckle tracking. We developed peak to valley strain index [(Peak to valley strain right − Peak to valley strain left)/Peak to valley strain maximum] to assess the symmetry of FVF deformation. ResultsThe difference in peak to valley strain between left and right FVF was significant in subjects with VFMI, whereas it was not in healthy controls. The peak to valley strain index was small (≤0.25) in symmetric FVF deformation in healthy controls whereas it was large (≥0.53) in asymmetric FVF deformation in subjects with VFMI. The area under receiver operating characteristics for peak to valley strain index in the determining asymmetric FVF deformation was 1. ConclusionOur results suggest that USI seems feasible to quantify both magnitude and symmetry of FVF deformation in adults. Further validation of USI in assessing VFMI is warranted.

Long-term Results of Artecoll Injection Laryngoplasty for Patients With Unilateral Vocal Fold Motion Impairment

To determine the long-term clinical efficacy and safety of injections of Artecoll, a soft-tissue filler consisting of a suspension of polymethyl methacrylate microspheres in a 3.5% solution of bovine collagen, into a vocal fold for managing glottal insufficiency secondary to unilateral vocal fold motion impairment. Single-institution retrospective study. A single tertiary care teaching hospital of Sungkyunkwan University School of Medicine. Ninety-six patients with unilateral vocal fold motion impairment. Percutaneous Artecoll injection laryngoplasty under local anesthesia. Acoustic, aerodynamic, and stroboscopic analyses were performed before injection and 1 week and 3, 6, and 12 months after injection. Two speech-language pathologists performed the perceptual assessment, and we used the subjective rating of hoarseness by the patients. The maximal phonation time, shimmer (amplitude variation), jitter (frequency variation), and ratio of noise to harmonic showed significant improvement 3 months after injection; these improvements were maintained 12 months after injection (P < .05). The GRBAS scale (overall grade of hoarseness, roughness, breathiness, asthenicity, and strain) grades and subjective patient-rated scores of hoarseness improved from 1 week after injection, and the improvements were maintained 12 months after injection (P < .05). We observed no significant early or delayed adverse events. Injection laryngoplasty with Artecoll is a safe, useful, and durable treatment option for the management of glottal insufficiency secondary to unilateral vocal fold motion impairment.

Management of vocal paralysis: A comparison of adult and pediatric practices

To compare practices of the American Broncho-Esophagological Association (ABEA) membership regarding the evaluation and management of unilateral vocal fold motion impairment (UVFMI) in adult versus pediatric populations. An 18-item adult survey and 16-item pediatric survey were administered to ABEA members. Seventy-six adult (31%) and 35 pediatric surveys (43%) were completed. Key differences are highlighted. With respect to etiology, the most common reported childhood cause is idiopathic; adults more often suffer iatrogenic paralysis. Children more commonly experience reflux disease, feeding difficulties, and choking. Preferred testing involves flexible laryngoscopy and chest x-ray; however, laboratory tests are carried out less often in children (51% vs 71%) and medical intervention is advocated by fewer pediatric practitioners (39% vs 57%). Significant disparities exist in the etiology, presenting symptoms, diagnostic testing, and medical treatment between children and adults with UVFMI. Clinicians' perceptions regarding UVFMI may reflect the differing impact of vocal paralysis in the pediatric versus adult populations.

Dysphagia, hoarseness, and unilateral true vocal fold motion impairment following anterior cervical diskectomy and fusion.

The charts of 100 patients who underwent anterior cervical diskectomy with fusion performed at our institution between January 1996 and February 1999 were reviewed. The incidences of hoarseness, dysphagia, and unilateral true vocal fold motion impairment were calculated. Univariate logistic regression was used to estimate the relationship of several patient and technical factors to the rates of occurrence of hoarseness and dysphagia. Patient age was found to be a significant predictor of postoperative dysphagia (p < .006), with an odds ratio of 1.113 (95% confidence limits, 1.04, 1.21) per year of age. Other factors studied were not found to be significant predictors. The overall incidence of these complications from the world literature was also calculated. The overall incidences of dysphagia, hoarseness, and unilateral true vocal fold motion impairment in the literature were calculated as 12.3%, 4.9%, and 1.4%, respectively. We conclude that dysphagia, hoarseness, and unilateral vocal fold motion impairment continue to remain significant complications of anterior cervical diskectomy with fusion. Older patients may be at higher risk for dysphagia.

Prevalence of aspiration and laryngeal penetration in patients with unilateral vocal fold motion impairment.

The adverse consequences of aspiration in regard to patient health and quality of life are well documented. It is generally accepted that the probability of aspiration is increased in patients with unilateral vocal fold motion impairment, however, the incidence and proposed mechanism of aspiration vary depending on the reported series. We reviewed the cine or video pharyngoesophagographic findings in patients with documented unilateral vocal fold motion impairment, identified through the Johns Hopkins Hospital Swallowing Center database, to determine the prevalence and cause of aspiration and laryngeal penetration. Aspiration and laryngeal penetration were identified in 38% and 12% of patients, respectively. Aspiration resulted from impaired airway protection, not from esophageal obstruction with laryngeal "spill-over." The number and degree of impairments directly correlated with probability of aspiration. Obstruction potentiated the likelihood of aspiration. Video pharyngoesophagography accurately identifies patients at risk for aspiration.

Pathophysiology and indications for medialization thyroplasty in patients with dysphagia and aspiration

Medialization thyroplasty is generally considered a phonosurgical procedure for voice augmentation in patients with glottic insufficiency. This article addresses specifically the issue of dysphagia and aspiration in patients with laryngeal paralysis. A retrospective review of patients undergoing medialization thyroplasty is performed. From 1991 to 1995, 84 patients at The Johns Hopkins Medical Institutions underwent medialization thyroplasty for unilateral vocal fold motion impairment. At presentation 48 patients had isolated recurrent laryngeal nerve injury, 26 with combined superior laryngeal nerve/recurrent laryngeal nerve injury and 10 with idiopathic nerve injury. Sixty-one percent of patients had swallowing difficulties. The severity of symptoms is greater in the superior laryngeal nerve/recurrent laryngeal nerve group. Before surgery 13 patients were dependent on feeding tubes. Nine patients improved to the point at which all alimentation was taken by mouth and tube feedings were discontinued after medialization thyroplasty. One patient was subsequently converted to a full oral diet after cricopharyngeal myotomy. Three patients remained dependent on feeding tubes. The pathophysiology of dysphagia including clinical and experimental observations is reviewed. In addition, the nonsurgical and surgical approaches to treatment of patients with laryngeal paralysis are reviewed. (Otolaryngol Head Neck Surg 1997;116:349-54.)

Pathophysiology and indications for medialization thyroplasty in patients with dysphagia and aspiration.

Medialization thyroplasty is generally considered a phonosurgical procedure for voice augmentation in patients with glottic insufficiency. This article addresses specifically the issue of dysphagia and aspiration in patients with laryngeal paralysis. A retrospective review of patients undergoing medialization thyroplasty is performed. From 1991 to 1995, 84 patients at The Johns Hopkins Medical Institutions underwent medialization thyroplasty for unilateral vocal fold motion impairment. At presentation 48 patients had isolated recurrent laryngeal nerve injury, 26 with combined superior laryngeal nerve/recurrent laryngeal nerve injury and 10 with idiopathic nerve injury. Sixty-one percent of patients had swallowing difficulties. The severity of symptoms is greater in the superior laryngeal nerve/recurrent laryngeal nerve group. Before surgery 13 patients were dependent on feeding tubes. Nine patients improved to the point at which all alimentation was taken by mouth and tube feedings were discontinued after medialization thyroplasty. One patient was subsequently converted to a full oral diet after cricopharyngeal myotomy. Three patients remained dependent on feeding tubes. The pathophysiology of dysphagia including clinical and experimental observations is reviewed. In addition, the nonsurgical and surgical approaches to treatment of patients with laryngeal paralysis are reviewed.