Disease Characteristics and Electromyographic Findings of Nonsurgery-Related Unilateral Vocal Fold Paralysis

Pei, Yu‐Cheng; Li, Hsueh‐Yu; Chen, Cheng‐Lun; Wong, May‐Kuen; Huang, Po‐Wei; Fang, Tuan‐Jen

doi:10.1002/lary.26329

Cited by 12 publications

(14 citation statements)

References 31 publications

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“…Husain et al showed that the time course of vocal recovery in IVFP follows a different pattern than that of iatrogenic vocal fold paralysis, with higher rates of recovery in the first 5 months in IVFP. Laryngeal electromyographic studies have shown that patients with IVFP have less severe denervation than those with vocal fold paralysis of known causes . Taken together, these data suggest that the pathophysiology of IVFP may be distinct from that of typical iatrogenic vocal fold paralysis.…”

Section: Introductionmentioning

confidence: 85%

“…This difference (53% vs. 22%) is probably more impressive than it seems because surgeries with known risk to both nerves accounted for 54 of the 107 patients, so the simultaneous RLN/SLN deficits were largely explainable in the iatrogenic group. To account for the large proportion of IVFP patients with simultaneous RLN/SLN deficits, Pei et al hypothesized that many cases of IVFP may be caused by neuritis involving the segment of the vagus nerve proximal to the takeoff point of the superior laryngeal nerve.…”

Section: Discussionmentioning

confidence: 99%

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Pathophysiology of iatrogenic and idiopathic vocal fold paralysis may be distinct

2019

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Objective: Spontaneous vocal recovery from idiopathic vocal fold paralysis (VFP) appears to differ in time course from recovery in iatrogenic VFP. This study aimed to determine if this difference could be explained by differing mechanisms causing recurrent laryngeal nerve (RLN) dysfunction, specifically whether idiopathic VFP is consistent with a focal RLN axonal lesion.Study Design: Case series with mathematical modeling.Methods: A review of 1267 cases of unilateral VFP over a 10-year period yielded 114 subjects (35 idiopathic, 79 iatrogenic) with a discrete onset of spontaneous vocal recovery. The time-to-recovery data were fit to a previously described two-phase model that incorporates the Seddon classification of neuropraxia and higher grades of axonal injury. Alternatively, the data were fit to a single phase model that does not assume a focal axonal lesion.Results: Time to vocal recovery in iatrogenic VFP can be reliably modeled by the assumption of a focal axonal lesion, with an early recovery group corresponding to neuropraxia and a late recovery group with more severe nerve damage. Time to recovery in idiopathic VFP can be more simply modeled in a single phase, with a time course that mirrors those in diverse biological processes such as transcription and microtubule growth.Conclusion: Idiopathic VFP may not be caused by a focal axonal lesion. Neuritis may be a compatible mechanism. The iatrogenic VFP data lend further support to the concept that the severity of RLN injury, not the length of axon to regenerate, is the chief determinant of recovery time after iatrogenic injury.

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Section: Introductionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Pathophysiology of iatrogenic and idiopathic vocal fold paralysis may be distinct

2019

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“…Neurogenic immobility can be caused by a disease process of any part of the vagus nerve from its origin in the medullary nucleus ambiguous or its supranuclear tracts in the brain, to the recurrent laryngeal nerve. 13 – 22 Brain tumors, from brainstem to jugular foramen, strokes, and demyelinating diseases are rarer etiologies. Recurrent laryngeal nerve paralysis can be also caused by non-neoplastic space-occupying lesions including aortic aneurysm, mitral stenosis, and mediastinal cysts.…”

Section: Possible Causes Of London’s Vocal Paralysismentioning

confidence: 99%

“…Systemic causes of recurrent laryngeal paralysis include lead poisoning, bacterial infections (such as diphtheria), or viral illness. More than 85% of UVCP 13 – 22 has three main causes: (1) nerve injury during surgery (of thyroid or mediastinum), (2) neoplastic invasion along the path of the recurrent laryngeal nerve, and (3) an inflammatory process usually due to a viral infection.…”

Section: Possible Causes Of London’s Vocal Paralysismentioning

confidence: 99%

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Unilateral Vocal Cord Paralysis of a Great Jewish Opera Singer

Duek

Cohen

Gil

2018

Rambam Maimonides Med J

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George London was one of the most compelling vocal artists of the early twentieth century. At the age of 47, the great bass-baritone retired from singing. It has been suggested that the premature ending of his operatic career was due to unilateral vocal cord palsy (UVCP). When London retired, the common belief was that this UVCP was caused by viral hepatitis, although there is no evidence to support such an etiology. London’s medical records eliminate the possible etiology of a neck neoplasm, and the long period of time between a heart attack he experienced and his diagnosis of UVCP makes a cardiovascular etiology an unlikely causative factor. London’s relatively young age, the diagnosis of laryngitis prior to his UVCP, and the course of his disease indicate that the underlying cause of the termination of his singing career was post-viral neuropathy. This paper describes the clinical evidence related to London’s vocal cord function and explores the possible causes for his UVCP, which apparently led to his early retirement.

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A comparative analysis of laryngeal nerve damage in patients with idiopathic vocal cord paralysis exhibiting different paralytic sides

Liu,

Yan,

et al. 2024

Laryngoscope Investig Oto

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ObjectiveTo assess the extent of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) damage in patients with idiopathic vocal cord paralysis (IVCP) exhibiting different paralytic sides.MethodsA total of 84 IVCP cases were evaluated using stroboscopic laryngoscopy, voice analysis, and laryngeal electromyography (LEMG). The results were compared between patients with left‐sided paralysis and right‐sided paralysis based on different disease courses (less than or more than 3 months).ResultsInitially, the average age and disease progression of IVCP patients were found to be similar regardless of the side of paralysis (p > .05). Additionally, there were no significant variations in voice indicators, such as MPT, DSI, and VHI, between IVCP patients with left and right vocal cord paralysis (p > .05). Furthermore, no disparities were detected in the latencies and amplitudes of the paralyzed RLN and SLN, as well as the durations and amplitudes of the action potentials in the paralyzed TM and PCM, among IVCP patients with left and right vocal cord paralysis (p > .05). Notably, the amplitudes of the left paralytic CM were significantly lower than those of the right paralytic CM (0.45 vs. 0.53, Z = −2.013, p = .044). In addition, no disparities were observed in APDs and amplitudes between the ipsilateral PCM and TM, either for patients with left or right vocal fold paralysis (p > .05). Finally, all the IVCP patients were subdivided into two subgroups according to different disease course (less than or more than 3 months), and in each subgroup, the comparison of voice indicators and LEMG results in IVCP patients with left or right vocal fold paralysis were similar with the above findings (p > .05).ConclusionOverall, the degree of RLN and SLN damage appeared to be similar in IVCP patients with left and right vocal cord paralysis, provided that the disease course was comparable.Level of Evidence4.

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Disease Characteristics and Electromyographic Findings of Nonsurgery-Related Unilateral Vocal Fold Paralysis

Abstract: 4. Laryngoscope, 127:1381-1387, 2017.

Cited by 12 publications

References 31 publications

Pathophysiology of iatrogenic and idiopathic vocal fold paralysis may be distinct

Pathophysiology of iatrogenic and idiopathic vocal fold paralysis may be distinct

Unilateral Vocal Cord Paralysis of a Great Jewish Opera Singer

A comparative analysis of laryngeal nerve damage in patients with idiopathic vocal cord paralysis exhibiting different paralytic sides

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