eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Vocal Fold Paralysis, Unilateral: Workup

Author: Thomas L Carroll, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Tufts University School of Medicine
Coauthor(s): Clark A Rosen, MD, Director, University of Pittsburgh Voice Center; Associate Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine; Ryan J Soose, MD, Assistant Professor, Department of Otolaryngology, University of Pittsburgh Medical Center
Contributor Information and Disclosures

Updated: Nov 6, 2008

Workup

Imaging Studies

  • Although rarely obtained today for the workup of unilateral vocal fold paralysis (UVFP), chest radiography can be the first screening evaluation for a patient with unilateral vocal fold paralysis (UVFP) of unknown etiology. This may reveal a chest malignancy as the cause of the unilateral vocal fold paralysis (UVFP). A Pancoast tumor, mediastinal mass, or even massive cardiomegaly may be found. The latter has rarely been shown to be a cause of unilateral vocal fold paralysis (UVFP) when enlargement of the left atrium that causes a stretch injury to the left recurrent laryngeal nerve is present.
  • CT scanning or MRI of the path of the vagus/recurrent laryngeal nerve  
    • CT scanning or MRI should be performed as part of a workup for a unilateral vocal fold paralysis (UVFP) of unknown etiology. The imaging should include the entire path of the vagus/recurrent laryngeal nerve involved. A left unilateral vocal fold paralysis (UVFP) involves imaging from the base of skull to the mid chest (arch of the aorta). The right unilateral vocal fold paralysis (UVFP) evaluation should extend from the base of the skull to the clavicle.
    • Although CT is usually the test of choice, the decision between CT scanning and MRI is personal and can be decided by the otolaryngologist and radiologist.

Other Tests

  • Voice evaluation: Voice evaluation by a speech-language pathologist is often helpful to determine the degree of maladaptive compensatory behavior present. In addition, voice recording provides documentation of the baseline voice quality and ability. This is important because treatment for the vocal fold paralysis usually begins shortly after evaluation. Often, this voice evaluation includes an objective analysis of the voice quality of the patient, including acoustic and aerodynamic analysis (air flow and laryngeal efficiency) of speech production.
  • Laryngeal electromyography (LEMG)
    • LEMG is an electrophysiologic evaluation of the muscles of the larynx. This test is performed using an EMG needle percutaneously under local or no anesthesia. The LEMG most often involves an evaluation of the thyroarytenoid/lateral cricoarytenoid muscle complex, which is reflective of the recurrent laryngeal nerve innervation and the cricothyroid muscle, which is indicative of the superior laryngeal nerve status/function.
    • LEMG findings can be diagnostic and prognostic and can therefore be a useful tool to guide therapy. LEMG can be used to differentiate between vocal fold immobility caused by cricoarytenoid joint pathology and that caused by vocal fold paralysis. The timing of LEMG is crucial in accurately determining the prognosis of spontaneous recovery of the paralyzed vocal fold. LEMG is most predictive of outcome if performed 6 weeks to 6 months after the onset of symptoms. LEMG can shorten the time until permanent treatment is implemented, subsequently reducing the time of the patient's dysphonia and the number of temporary treatments required.

More on Vocal Fold Paralysis, Unilateral

Overview: Vocal Fold Paralysis, Unilateral
Workup: Vocal Fold Paralysis, Unilateral
Treatment: Vocal Fold Paralysis, Unilateral
Follow-up: Vocal Fold Paralysis, Unilateral
Multimedia: Vocal Fold Paralysis, Unilateral
References
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References

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  2. Zeitels SM, Hillman RE, Desloge RB, et al. Cricothyroid subluxation: a new innovation for enhancing the voice with laryngoplastic phonosurgery. Ann Otol Rhinol Laryngol. Dec 1999;108(12):1126-31. [Medline].

  3. Amin MR. Thyrohyoid approach for vocal fold augmentation. Ann Otol Rhinol Laryngol. Sep 2006;115(9):699-702. [Medline].

  4. Belafsky PC, Postma GN. Vocal fold augmentation with calcium hydroxylapatite. Otolaryngol Head Neck Surg. Oct 2004;131(4):351-4. [Medline].

  5. Bielamowicz S, Stager SV. Diagnosis of unilateral recurrent laryngeal nerve paralysis: laryngeal electromyography, subjective rating scales, acoustic and aerodynamic measures. Laryngoscope. Mar 2006;116(3):359-64. [Medline].

  6. Branski R, Murry T, Rosen CA. Voice Therapy. In: Otolaryngology and Facial Plastic Surgery. 2000:[Full Text].

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  8. Hertegard S, Hallen L, Laurent C, et al. Cross-linked hyaluronan versus collagen for injection treatment of glottal insufficiency: 2-year follow-up. Acta Otolaryngol. Dec 2004;124(10):1208-14. [Medline].

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  12. Laccourreye O, Papon JF, Kania R, et al. Intracordal injection of autologous fat in patients with unilateral laryngeal nerve paralysis: long-term results from the patient's perspective. Laryngoscope. Mar 2003;113(3):541-5. [Medline].

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  17. Rosen CA. Complications of phonosurgery: results of a national survey. Laryngoscope. Nov 1998;108(11 Pt 1):1697-703. [Medline].

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  20. Shaw GY, Szewczyk MA, Searle J, et al. Autologous fat injection into the vocal folds: technical considerations and long-term follow-up. Laryngoscope. Feb 1997;107(2):177-86. [Medline].

  21. Umeno H, Shirouzu H, Chitose S, et al. Analysis of voice function following autologous fat injection for vocal fold paralysis. Otolaryngol Head Neck Surg. Jan 2005;132(1):103-7. [Medline].

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Further Reading

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Keywords

unilateral vocal fold paralysis, UVFP, vocal cord paralysis, neurogenic hoarseness, vocal cord paralysis, larynx, neurogenic hoarseness

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Contributor Information and Disclosures

Author

Thomas L Carroll, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Tufts University School of Medicine
Thomas L Carroll, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Clark A Rosen, MD, Director, University of Pittsburgh Voice Center; Associate Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine
Clark A Rosen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Pennsylvania Medical Society
Disclosure: Bioform Medical  Consulting fee Consulting

Ryan J Soose, MD, Assistant Professor, Department of Otolaryngology, University of Pittsburgh Medical Center
Ryan J Soose, MD is a member of the following medical societies: Alpha Omega Alpha and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

John Schweinfurth, MD, Associate Professor, Department of Otolaryngology, University of Mississippi Medical Center
John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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