Vocal Cord Paralysis In Patients Research Articles

The risk factors for postoperative temporary vocal cord paralysis after thyroid cancer surgery: an observational retrospective cohort study.

To analyze the potential factors influencing new-onset postoperative transient vocal cord paralysis (VCP) in thyroid cancer patients. Case information of 8,340 thyroid cancer patients hospitalized at XX from January 2018 to December 2020 was collected retrospectively and analyzed. The possible influencing factors were analyzed using a chi-square test, rank-sum test, and multiple logistic regression analysis. A nomogram was used to construct the clinical prediction model that was validated in the validation set by ROC, calibration curves, and DCA. The STROCSS guideline was followed to conduct a retrospective cohort study. A total of 8,340 patients, including 1,817 (21.8%) men and 6,523 (78.2%) women, were enrolled in this study. The rate of temporary VCP was 3.6% (308/8,340). Based on the results of postoperative laryngoscopy, the patients were divided into VCP group and non-VCP group. Comparative analysis between the groups revealed that potential factors associated with postoperative transient VCP were tumor location on the dorsal side of the gland (P = 0.042), ultrasound showing a maximum nodal diameter > 1 cm (P = 0.002), multifocal carcinoma (P < 0.001), invasion of surrounding tissue (P = 0.005), lymph node metastases in the central compartment (P = 0.034), lateral cervical lymph node metastasis (P < 0.001), and prolonged operation (P < 0.001). A multiple logistic regression analysis showed that the independent risk factors in postoperative transient VCP were T stage (OR = 1.411, P = 0.013, 95% CI: 1.075-1.853), multifocal carcinoma (OR = 1.532, P = 0.013, 95% CI: 1.095-2.144), and duration of surgery (OR = 1.009, P < 0.001, 95% CI: 1.006-1.012). Finally, a clinical prediction model was established via a nomogram and was validated in the validation set, although its diagnostic efficacy needs to be improved further. High T stage, multifocal carcinoma, and prolonged operation time may be independent risk factors for the occurrence of postoperative transient VCP in patients undergoing initial surgery for thyroid cancer.

Bilateral vocal cord paralysis and airway obstruction during postoperative period after partial glossectomy

Bilateral vocal cord paralysis is a rare complication of endotracheal intubation, causing serious problems. We report a case of bilateral vocal cord paralysis and airway obstruction in the postoperative period after partial glossectomy. A 61-year-old male patient with diabetes mellitus underwent partial glossectomy under general anesthesia. The anesthesia during surgery was uneventful. After extubation, the patient appeared to have airway obstruction and complained of dyspnea. Flexible fiberoptic laryngoscopy was performed immediately, and the patient was diagnosed with bilateral vocal cord paralysis. Therefore, reintubation was performed. The patient was extubated the following day and discharged with incomplete recovery of vocal cord paralysis. The study findings indicate that inappropriate endotracheal tube location and cuff pressure can cause bilateral vocal cord paralysis. The involvement of head position and tongue traction during glossectomy was suggested in this case. Anesthesiologists should be able to consider and manage bilateral vocal cord paralysis in patients with airway obstruction in the postoperative period.

Etiology and presenting features of vocal cord paralysis: changing trends over the last two decades

BackgroundThe study was performed to evaluate the changing trends in etiology and presenting features of vocal cord paralysis (VCP) from March 1998 to March 2020.MethodsPatient’s record collected from hospital database and divided into two groups, from March 1998 to March 2009 and from April 2009 to March 2020, to evaluate the changing trends in etiology and presenting features.ResultsTotal of 711 VCP patients, 80.3% with unilateral (UVCP) and 19.7% with bilateral vocal cord paralysis (BVCP) included. The commonest etiology was non-surgical (57.1%) for UVCP and surgical (55.7%) for BVCP. The commonest surgical etiology was thyroid and parathyroid surgery for both UVCP (16.6%) and BVCP (38.5%). The commonest non-surgical etiology was idiopathic for UVCP (23.1%) and malignancies for BVCP (13.6%). There was increase in surgical etiology for both UVCP (39.3 to 45.3%) and BVCP (51.2 to 57.7%), and decrease in non-surgical etiology for both UVCP (60.7 to 54.6%) and BVCP (48.8 to 42.3%). The change in voice was most common presenting features for both UVCP (69.2%) and BVCP (92.8%). The frequency of the presenting features was comparable, with decrease in the duration of symptom onset over the time period.ConclusionThe most common etiology for UVCP was idiopathic, and for BVCP was thyroid and parathyroid surgery. For both, UVCP and BVCP there was increasing trend for surgical and decreasing trend for non-surgical etiology. The change in voice was the most common presenting complain, with decrease in duration of symptom onset over time period.

Longitudinal experience of patients with post-thyroidectomy vocal cord paralysis

BackgroundPrior studies of post-thyroidectomy vocal cord paralysis (VCP) present static and limited evaluations. We comprehensively assessed the experience of patients with VCP post-thyroidectomy over 1 year. MethodsVoice Handicap Index (VHI), Eating Assessment Tool (EAT-10), 12-Item Short Form Survey (SF-12), and qualitative interviews were assessed preoperatively, and 2-weeks, 6-weeks, 6-months, and 1-year postoperatively. Outcomes7 of 44 patients (15.9%) had postoperative VCP. Compared to those without complication, mean VHI scores for VCP patients increased significantly from baseline at 2-weeks (27.9 point increase vs 1.6, p < 0.01) and 6-weeks (26.3 vs. −0.3, p < 0.01) postoperative. There were no significant differences between groups in SF-12 or EAT-10 scores at any point. Qualitative interviews showed that both groups noted bothersome voice symptoms at 2-weeks; however, by 6-weeks, only VCP patients noted voice symptoms negatively affecting their life. ConclusionWhile both patients with and without VCP reported subjective voice symptoms immediately postoperatively, those with VCP had worse quantitative measures. Understanding the longitudinal experience of VCP can help providers tailor counseling for these patients.

Recurrent Laryngeal Nerve Invasion by Thyroid Cancer: Laryngeal Function and Survival Outcomes.

Recurrent laryngeal nerve (RLN) invasion by thyroid carcinoma represents an advanced disease status with potentially significant co-morbidity. In a retrospective single-center study, we included patients with invaded RLNs operated on while using nerve monitoring techniques. We studied pre-, intra-, and postoperative parameters associated with postoperative vocal cord paralysis (VCP); 5-year recurrence-free survival (RFS); and 5-year overall survival (OS) in addition to two subgroup analyses of postoperative VCP in patients without preoperative VCP and based on source of RLN invasion. Of 65 patients with 66 nerves-at-risk, 39.3% reported preoperative voice complaints. Preoperative VCP was documented in 43.5%. The RLN was invaded by primary tumor in 59.3% and nodal metastasis in 30.5%. Papillary thyroid carcinoma was the most common pathologic subtype (80%). After 6 months, 81.8% had VCP. Complete tumor resection of the RLN was not associated with 5-year RFS (p=0.24) or 5-year OS (p=0.9). Resecting the RLN did not offer statistically significant benefit on 5-year RFS (p=0.5) or 5-year OS (p=0.38). Radioactive Iodine (RAI) administration was associated with improvement in 5-year RFS (p=0.006) and 5-year OS (p=0.004). Patients without preoperative VCP had higher IONM amplitude compared with patients with VCP. After a mean follow-up of 65.8 months, 35.9% of patients had distant metastases, whereas 36.4% had recurrence. Preoperative VCP accompanies less than half of patients with RLN invasion. Invaded RLNs may have existent electrophysiologic stimulability. Complete tumor resection and RLN resection were not associated with better 5-year RFS or OS, but postoperative RAI was. 4 Laryngoscope, 132:2285-2292, 2022.

Etiology of unilateral vocal cord paralysis: A 16-year retrospective review

Introduction: Vocal fold paralysis is a common clinical entity. Vocal fold immobility is defined as the restriction of movement of the vocal folds secondary to neuropathy or mechanical fixation. Neurogenic immobility may result from damage to the vagus and recurrent laryngeal nerve. Unilateral vocal cord paralysis (UVCP) is a highly variable clinical entity that warrants a thorough evaluation to assess the functional status of the larynx and to determine the etiology. Vocal fold paralysis is a sign of an underlying disease, not a disease in itself, and finding its etiology determines its prognosis and management options. Aims and Objectives: To study the etiology of unilateral vocal cord paralysis in patients in a tertiary referral centre Materials and Methods: The present study was conducted in a tertiary referral center between January 2003 and December 2019. A retrospective review of the case records of all patients diagnosed with UVCP who presented to us was carried out. A total of 435 cases who met the inclusion criteria were considered. The etiology of UVCP was determined using history, examination and appropriately directed investigations. Observation and Results: The most common identifiable cause of UVCP in our study was found to be surgical trauma, followed by non laryngeal malignancies. Conclusion: Though surgical trauma has been found to be the most common etiological factor in UVCP, a large proportion of patients had idiopathic UVCP and further research as to the pathophysiology of these cases is warranted.

Incidence, Risk Factors, and Comorbidities of Vocal Cord Paralysis After Surgical Closure of a Patent Ductus Arteriosus: A Meta-analysis

Surgical closure of a patent ductus arteriosus (PDA) is considered standard treatment for symptomatic neonates refractory to medical therapy. Sometimes, iatrogenic injury to the left recurrent laryngeal nerve during the procedure can result in vocal cord paralysis (VCP). This study aimed to estimate the incidence of VCP in patients after surgical PDA closure and to identify any associated risk factors and morbidities associated with VCP in the preterm infant population. A thorough search of the major electronic databases was conducted to identify studies eligible for inclusion into this meta-analysis. Studies reporting data on the incidence of VCP (primary outcomes) or risk factors and morbidities associated with VCP in premature infant population (secondary outcomes) were included. A total of 33 studies (n = 4887 patients) were included into the analysis. Overall pooled incidence estimate of VCP was 7.9% (95%CI 5.3–10.9). The incidence of VCP after PDA closure was significantly much higher in premature infants (11.2% [95%CI 7.0–16.3]) than in non-premature patients (3.0% [95%CI 1.5–4.9]). The data showed that VCP was most common after surgical ligation and in studies conducting universal laryngoscopy scoping. The risk factors for postoperative VCP in preterm infants included birth weight and gestational age. In addition, VCP was significantly associated with the occurrence of bronchopulmonary dysplasia, gastrostomy tube insertion, and increased duration of mechanical ventilation. Vocal cord paralysis remains a frequent complication of surgical closure of a PDA, especially in premature neonates, and is associated with significant post-procedural complications.

Upper airway obstruction in neonates: Does sleep exacerbate symptoms?

ObjectiveDescribe the factors that exacerbate upper airway obstructions (UAOs) in neonates.Study DesignRetrospective chart review.SettingPediatric tertiary care hospital.Subjects and MethodsAll neonates hospitalized between 1/1/2010 and 12/31/2014 diagnosed with either: 1) laryngomalacia, 2) Pierre Robin sequence, or 3) vocal cord paralysis were included in this study. Patient charts were reviewed to determine factors that exacerbated symptoms of airway obstruction. The independent variable was patient diagnosis, and the outcome measure was exacerbating factors.ResultsIn patients with laryngomalacia (n = 31), 41.9% worsened with agitation, 38.7% worsened with feeding, 16.1% worsened with positioning, 0.0% worsened during sleep, and 25.8% had no aggravating factors. In Pierre‐Robin patients (n = 31), 48.4% worsened with agitation, 16.1% worsened with feeding, 61.3% worsened with positional changes, 0.0% worsened during sleep, and 12.9% had no aggravating factors. In vocal cord paralysis patients (n = 25), 72.0% worsened with agitation, 8.0% worsened with feeding, 20.0% worsened with positional changes, 4.0% worsened during sleep, and 24.0% had no aggravating factors.ConclusionAirway obstruction was not reliably exacerbated during sleep for any of the diagnoses studied in this review. Our findings show that agitation exacerbates airway obstruction in most patients with vocal cord paralysis, and positioning exacerbates airway obstruction in the majority of patients with PRS. Aggravating factors in laryngomalacia are variable. These findings question the utility of polysomnography as a diagnostic tool for hospitalized neonates with these conditions.Level of Evidence4.

Surgical Methods and Experiences of Surgeons did not Significantly Affect the Recovery in Phonation Following Reconstruction of the Recurrent Laryngeal Nerve.

BackgroundWe reported phonatory recovery in the majority of 88 patients after recurrent laryngeal nerve (RLN) reconstruction. Here we analyzed factors that might influence the recovery, in a larger patient series.MethodsAt Kuma Hospital, 449 patients (354 females and 95 males) underwent RLN reconstruction with direct anastomosis, ansa cervicalis-to-RLN anastomosis, free nerve grafting, or vagus-to-RLN anastomosis; 47.4 % had vocal cord paralysis (VCP) preoperatively. Maximum phonation time (MPT) and mean airflow rate during phonation (MFR) were measured 1 year post surgery. Forty patients whose unilateral RLNs were resected and not reconstructed and 1257 normal subjects served as controls.ResultsCompared to the VCP patients, the RLN reconstruction patients had significantly longer MPTs 1 year after surgery, nearing the normal values. The MFR results were similar but less clear. Detailed analyses of 228 female patients with reconstruction for whom data were available revealed that none of the following factors significantly affected phonatory recovery: age, preoperative VCP, method of reconstruction, site of distal anastomosis, use of magnifier, thickness of suture thread, and experience of surgeon. Of these 228 patients, 24 (10.5 %) had MPTs <9 s 1 year after surgery, indicating insufficient recovery in phonation. This insufficiency was also not associated with the factors mentioned above.ConclusionsApproximately 90 % of patients who needed resection of the RLN achieved phonatory recovery following RLN reconstruction. The recovery was not associated with gender, age, preoperative VCP, surgical method of reconstruction, or experience of the surgeon. Performing reconstruction during thyroid surgery is essential whenever the RLN is resected.

Prevalence of Vocal Cord Paralysis in Patients with Incidentally Discovered Enlarged Lymph Nodes along the Expected Course of the Recurrent Laryngeal Nerve

We sought to determine the prevalence of vocal cord paralysis in patients with incidentally discovered lymphadenopathy along the expected course of the recurrent laryngeal nerve (RLN). We reviewed the positron-emission tomographic (PET) and computed tomographic (CT) scans of 936 consecutive patients with a variety of diagnoses. Enlarged lymph nodes (short-axis diameter of more than 1 cm) along the expected course of the RLN were identified. Patients with lymphadenopathy were evaluated for CT signs of vocal cord paralysis. The medical records of patients with lymphadenopathy were reviewed for clinical signs of vocal cord paralysis. Patients with head and neck malignancies were excluded from the study. Lymphadenopathy along the course of the RLN was identified in 57 of the 936 patients studied. Fifty-three of the 57 patients (93%) were found to have a malignancy. Thirty-four enlarged nodes (60%) had FDG uptake as shown on a PET/CT scan. Twenty enlarged nodes (35%) had CT evidence of extracapsular spread. Four patients (7%) had CT evidence of vocal cord paralysis. One patient (2%) had clinical evidence of vocal cord paralysis. In asymptomatic patients with incidental lymphadenopathy along the course of the RLN, vocal cord paralysis is rare.

Vocal Cord Paralysis After Aortic Surgery

The purpose of this study was to investigate variables associated with vocal cord paralysis during complex aortic procedures. A retrospective review. A tertiary care center. Four hundred ninety-eight patients who underwent aortic surgery between 2002 and 2007. Two groups were studied. Group A patients had procedures only involving their aortic root and/or ascending aorta. Group B patients had procedures only involving their aortic arch and/or descending aorta. The incidence of vocal cord paralysis was higher (7.26% v 0.8%) in group B patients (p < 0.0001). Increasing the duration of cardiopulmonary bypass time was associated with an increased risk of vocal cord paralysis and death in both groups A and B (p = 0.0002 and 0.002, respectively). Additionally, within group B, descending aneurysms emerged as an independent risk factor associated with vocal cord paralysis (p = 0.03). Length of stay was statistically significantly longer among group A patients who suffered vocal cord paralysis (p = 0.017) and trended toward significance in group B patients who suffered vocal cord paralysis (p = 0.059). The association between tracheostomy and vocal cord paralysis among group A patients reached statistical significance (p = 0.007) and trended toward significance in group B patients (p = 0.057). Increasing duration of cardiopulmonary bypass time was associated with a higher risk of vocal cord paralysis in patients undergoing aortic surgery. Additionally, within group B patients, descending aortic aneurysm was an independent risk factor associated with vocal cord paralysis. Most importantly, vocal cord paralysis appeared to have an association between an increased length of stay and tracheostomy among a select group of patients undergoing aortic surgery.

Utility of Injection Laryngoplasty in the Management of Post-Thyroidectomy Vocal Cord Paralysis

This prospective study investigated the efficacy of injection laryn-goplasty in the management of postthyroidectomy vocal cord paralysis (VCP). From March 2005 to December 2008, 174 consecutive injection laryngoplasties were performed in patients with unilateral glottic insufficiency. This included 34 patients with post-thyroidectomy VCP: 15 with temporary VCP and 19 with permanent VCP. Percutaneous injection was performed under local anesthesia into the vocalis muscle, using disposable 25G-long needles through the cricothyroid membrane or directly through the thyroid cartilage. Patients completed the acoustic, aerodynamic, perceptual, stroboscopic, and voice handicap index evaluations before and at 3 and 6 months after the injection. All injection laryngoplasty could be performed under local anesthesia without morbidity. Acoustic and perceptual parameters (overall grade of hoarseness, roughness, breathiness, asthenia, and strain), maximum phonation time, jitter, and shimmer, voice handicap index, and grades of mucosal waves and glottic closure were significantly improved after the injection and they remained stable over 6 months in both the temporary VCP and permanent groups (p < 0.05). Based on these preliminary results, injection laryngoplasty improved the voice, and voice-related quality of life in patients with post-thyroidectomy VCP. It is a simple, safe, and useful method for rehabilitating post-thyroidectomy VCP patients.

Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve

We report vocal improvement after reconstruction of the recurrent laryngeal nerve (RLN) in patients with nerve resection, although vocal cord movement was not restored. These methods are not widely recognized. Direct anastomosis, free nerve grafting, or anastomosis to the ansa cervicalis or the vagus nerves with the RLN were performed in 7, 14, 65, and 2 patients with thyroid cancer invading the RLN, respectively. A total of 51 patients had vocal cord paralysis (VCP) pre-operatively. Maximum phonation time (MPT) and vital capacity (VC) were measured before and 1 year after reconstruction. A total of 34 normal subjects and 27 patients with VCP served as controls. Patients with VCP had significantly shorter MPT values than normal subjects. At 1 year after operation, patients with reconstruction had values of MPT similar to those of normal subjects. Men had significantly longer MPT values than women, but the phonation efficiency index (PEI), defined as the MPT/VC ratio, did not differ by sex. The PEI was significantly less in VCP patients than in normal subjects. Patients with reconstruction achieved PEI values similar to those in normal subjects. Phonation efficiency index values at 1 year after operation was significantly greater than pre-operative PEI and was not affected by the presence or absence of VCP pre-operatively, age, reconstruction method, thickness of suture thread, or use of magnification during the operation. In patients with thyroid cancer requiring RLN resection, RLN reconstruction achieved recovery in phonatory function.

Frequency of transient ipsilateral vocal cord paralysis in patients undergoing carotid endarterectomy under local anesthesia

Especially because of improvements in clinical neurologic monitoring, carotid endarterectomy done under local anesthesia has become the technique of choice in several centers. Temporary ipsilateral vocal nerve palsies due to local anesthetics have been described, however. Such complications are most important in situations where there is a pre-existing contralateral paralysis. We therefore examined the effect of local anesthesia on vocal cord function to better understand its possible consequences. This prospective study included 28 patients undergoing carotid endarterectomy under local anesthesia. Vocal cord function was evaluated before, during, and after surgery (postoperative day 1) using flexible laryngoscopy. Anesthesia was performed by injecting 20 to 40 mL of a mixture of long-acting (ropivacaine) and short-acting (prilocaine) anesthetic. All patients had normal vocal cord function preoperatively. Twelve patients (43%) were found to have intraoperative ipsilateral vocal cord paralysis. It resolved in all cases < or =24 hours. There were no significant differences in operating time or volume or frequency of anesthetic administration in patients with temporary vocal cord paralysis compared with those without. Local anesthesia led to temporary ipsilateral vocal cord paralysis in almost half of these patients. Because pre-existing paralysis is of a relevant frequency (up to 3%), a preoperative evaluation of vocal cord function before carotid endarterectomy under local anesthesia is recommended to avoid intraoperative bilateral paralysis. In patients with preoperative contralateral vocal cord paralysis, surgery under general anesthesia should be considered.

Effects of unilateral vocal cord paralysis on objective voice measures obtained by Praat

Unilateral vocal cord paralysis (VCP) affects the objective properties of voice by diminished neurologic control and degenerative changes in laryngeal tissue. The goal of this study was to compare the acoustic parameters of VCP patients with control volunteers using the software Praat. Acoustic analysis results of 18 unilateral VCP patients were compared with age and sex matched 72 normal adult volunteers. Comparison of acoustic analysis results of male and female VCP patients with their age and sex matched control groups revealed statistically significant difference in jitter, shimmer, and noise-to-harmonics ratio values (P < 0.01) in both groups. There were no differences in mean fundamental frequency and intensity values. We conclude that these differences were in accordance with the results obtained by commercially available voice analysis programs. This study reflects the first results obtained with Praat software in VCP patients. Using the software Praat, is free and easy, that supports the clinician to rely on objective scientific data.

Transient Vocal Cord Paralysis After Fine-Needle Aspiration Biopsy of Thyroid Tumor

Complications of thyroid fine-needle aspiration biopsy (FNAB) are exceedingly rare. Hematoma formation is the most commonly encountered complication. Infection and seeding of carcinoma cells in the needle track has also been reported in a rare case. Here we describe patients diagnosed as having transient vocal cord paralysis after FNAB of benign thyroid tumor. Retrospective review of patients with concurrent diagnosis of vocal cord paralysis after FNAB. Among 10,974 patients who underwent FNAB, 4 patients showed vocal cord paralysis on laryngoscopy. These patients had solid and/or cystic lesion in the thyroid. Routine FNAB of the nodule was performed using a 23-gauge needle. Cytologic findings were benign tumor. Change of voice in the patients occurred 1 or 2 days after FNAB and vocal cord paralysis ipsilateral to FNAB was determined by flexible laryngoscopy. Vocal cord paralysis of all patients resolved spontaneously within 6 months (average, 4 months). Although the incidence of vocal cord paralysis in patients with thyroid tumor after FNAB is reported to be 0.036%, the true incidence is unknown because asymptomatic subjects are not screened. This report should alert the examiner to the possibility of vocal cord palsy after FNAB.

Nonrecurrent laryngeal nerves and their clinical significance

The anomalous position of a nonrecurrent laryngeal nerve predisposes the nerve to injury during thyroidectomy and to compression by a thyroid mass. We present four cases in which a seemingly benign thyroid mass traumatized a nonrecurrent laryngeal nerve resulting in either vocal cord paralysis or a vague pressure sensation over the larynx. Some of these patients feel as if they need to clear a foreign body and present with a chronic cough. Normally the nerve is protected from thyroid masses as it passes through the tracheoesophageal groove. In all four patients, surgical excision of the thyroid mass and release of the nerve resulte in recovery of the nerve and resolution of the symptoms. We have found that small, benign, or otherwise asymptomatic lesions of the thyroid gland have a greater tendency to cause vocal cord paralysis in patients with nonrecurrent laryngeal nerves. The surgeon must always be aware of the possibility of the presence of a nonrecurrent laryngeal nerve.

Airway function tests and vocal cord paralysis in lung transplant recipients

Maximum expiratory and inspiratory flow-volume (MEFV, MIFV) curves, specific airway conductance (sGaw), and flexible fiberoptic laryngoscopy were examined in 8 pediatric lung transplant recipients with vocal cord paralysis (VCP). Six were heart-lung (H-L) and 2 double-lung (D-L) recipients, 7 had left VCP, and 1 had right VCP. Based on the pulmonary function tests (PFT), 2 subgroups could be distinguished in the 8 recipients with VCP. Group A (5/8 recipients; mean age, 13 +/- 3.4 years; mean height, 144.3 +/- 12.3 cm) had significantly reduced specific airway conductance (sGaw; < 2 SD from predicted) and normal MEF25, MEF50, peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), and %FEV1/forced vital capacity (FVC); this pattern suggested variable extrathoracic airway obstruction. PIF was normal in 4/5 and reduced in 1/5 of these recipients. Group B (3/8 recipients with VCP; mean age, 17 +/- 2.4 years; mean height, 156.3 +/- 12.0 cm) had significantly reduced sGaw, MEF25, MEF50, PEF, FEV1, and %FEV1/FVC, implying primarily small airway obstruction. These recipients had bronchiolitis obliterans. The results suggest that a pattern of reduced sGaw and normal MEFs, PEF, FEV1, and PIF should raise the possibility of VCP in patients after lung transplantation. sGaw is more sensitive than PIF and PEF in identifying airway obstruction due to VCP, and should be routinely included in the follow-up evaluation of lung transplant recipients.

Vocal cord medialization for unilateral paralysis associated with intrathoracic malignancies

Patients with unilateral vocal cord paralysis from intrathoracic malignancies may have significant dysfunctions of speech, swallowing, ventilation, and effective coughing as a result of inadequate compensation of the nonparalyzed cord. In patients with already compromised pulmonary function, aspiration can be a life-threatening event. Sixty-three patients with intrathoracic malignancies required surgical correction of vocal cord paralysis. Primary pathology included lung cancer (49), esophageal cancer (nine), and miscellaneous tumors (five). Symptoms included hoarseness (62), dyspnea (21), aspiration (26), weight loss (19), dysphagia (14), and pneumonia (14). The surgical procedures included medial displacement of the vocal cord with silicone elastomer (48), temporary Gelfoam injection (seven), and Teflon (polytetrafluoroethylene) injection (eight) to move the affected cord to a medial position. In 11 patients, the operation was performed in the acute postoperative setting to improve pulmonary toilet. Symptomatic improvement was noted in the following proportions of affected patients: hoarseness, 92%; dyspnea, 90%; dysphagia, 93%; aspiration, 92%; pneumonia, 93%; and weight loss, 47%. Overall success rate of the intervention was 57 of 63 patients (90%). All 11 patients treated in the acute setting had immediate improvement. A variety of complications occurred in 17% of patients. Surgical management of vocal cord paralysis in patients with intrathoracic malignancies prevents life-threatening pulmonary complications in the acute postoperative setting. In chronic situations, it provides patients with improved speech, swallowing, and pulmonary function, resulting in improved quality of life, even for patients not cured of their disease. (J T HORAC C ARDIOVASC S URG 1996;111:334-41)

Vocal cord paralysis in patients with thoracic esophageal carcinoma

Of 478 consecutive patients with intrathoracic esophageal carcinoma, 5% had vocal cord paralysis. In two thirds of the patients with vocal cord paralysis, the paralysis was caused by a metastatic lymph node located along the recurrent laryngeal nerve. These findings indicate that the possibility exists for radical surgery by esophagectomy and resection of the metastatic lymph node infiltrating the recurrent laryngeal nerve, even in patients with vocal cord paralysis. However, in only two patients was radical surgery accomplished. None of the 24 patients with paralysis survived without disease for more than 1 year. Thus, in patients with vocal cord paralysis, the need for combined therapy should be emphasized.