Prevalence, incidence, and characteristics of dysphagia in those with unilateral vocal fold paralysis

Abstract

Objectives/Hypothesis The purpose of this study was to investigate the impact of dysphagia definition on the incidence and overall prevalence of dysphagia in patients with unilateral vocal fold paralysis (UVP) stratified by etiology. Study Design Retrospective medical chart review. Methods Data was collected from the records of individuals diagnosed with UVP from 2013 to 2018, including patient demographics, dysphagia questionnaire total scores, clinical evaluation dysphagia symptoms, and instrumental swallow assessment outcomes. The annual incidence and overall prevalence of dysphagia were calculated by etiology as counts and percentages across five operational definitions of dysphagia. Results A total of 415 individuals met inclusion criteria for the study. Annual prevalence estimates ranged from 19% to 55%, depending on the definition of dysphagia used. The highest prevalence of dysphagia occurred when defined by symptoms or signs identified by the clinician (55%). The lowest prevalence of dysphagia occurred using a definition of abnormal swallowing function documented during instrumental assessment (19%). Dysphagia questionnaire scores were more frequently abnormal in those with iatrogenic than idiopathic etiology of UVP (adjusted P = 0.014). Rate of instrumental assessment and documentation of aspiration was highest for central UVP etiology (33%). On average, pneumonia was rare (6%) irrespective of UVP etiology. Conclusion Up to 55% of patients diagnosed with UVP complained of dysphagia, but only 21% had dysphagia symptoms severe enough to prompt instrumental assessment. Incidence and severity of dysphagia varied depending on UVP etiologic category as well as dysphagia definition. The etiology of UVP may impact dysphagia risk and severity in this population and warrants further investigation. Level of Evidence IV Laryngoscope, 130:2397–2404, 2020

Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

“…For voice parameters, the F0, jitter, shimmer, MPT, and NHR were reported. Three articles (27.27%) used VHI for quality of life assessment [ 1 , 2 , 4 ], but eight articles (72.72%) did not report [ 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. The assessment time was undertaken pre-and post-operation as early as one week to 12 months.…”

“…Quality of life is compromised in speech and swallowing in patients with unilateral vocal fold paralysis (UVFP). Because of recurrent laryngeal nerve neuropathy, inadequate glottic closure is frequently found because of idiopathic, neoplasm, or iatrogenic causes [ 1 ]. The surgical treatment includes injection laryngoplasty, laryngeal framework surgery, recurrent laryngeal nerve (RLN) re-innervation, and laryngeal pacing [ 2 ].…”

Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment

“…9 Dysphonia is the most common symptom, with rates of voice disturbance following thyroidectomy ranging from 30% to 87%. 18 Dysphagia has been reported in 55% to 69% of patients with VFP, [11][12][13] resulting in aspiration pneumonia in up to 6%. 11 Although less well recognized, dyspnea is also a common symptom in unilateral VFP, with a reported prevalence as high as 76%.…”

“…18 Dysphagia has been reported in 55% to 69% of patients with VFP, [11][12][13] resulting in aspiration pneumonia in up to 6%. 11 Although less well recognized, dyspnea is also a common symptom in unilateral VFP, with a reported prevalence as high as 76%. 18 Proposed causes of dyspnea include hyperventilation 19 and passive medialization of the flaccid vocal fold with inspiration resulting from laryngeal airflow and turbulence.…”

“…If pathology is identified, a careful analysis of associated risk factors such as patient's age, symptoms, patient's desire to get assistance, risk of aspiration, mechanism of injury, and intraoperative electrophysiological data should be collected to determine the need for treatment. There is strong evidence that early treatment for unilateral VFP improves outcomes from a voice and aspiration prevention standpoint 8,11‐13 (Figure 1).…”