Unilateral Vocal Fold Paralysis and Paresis

Chadwick, K.; Sulica, Lucian

doi:10.1007/978-3-030-58494-8_4

Cited by 1 publication

(5 citation statements)

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“…21 Perceived dyspnea may be related to loss of normal glottic valving function and air leak through the glottis during functions normally requiring complete glottic closure. 4 If so, restoring glottic closure could alleviate dyspnea. In this study, based on a patient-reported outcome measure developed for upper airway-elated dyspnea, there was a significant reduction in dyspnea-related symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Others have felt that reduced airflow is offset by improved breath control afforded by eliminating the vocal fold flaccidity and dynamic respiratory obstruction 21 . Perceived dyspnea may be related to loss of normal glottic valving function and air leak through the glottis during functions normally requiring complete glottic closure 4 . If so, restoring glottic closure could alleviate dyspnea.…”

Section: Discussionmentioning

confidence: 99%

“…3 The lack of glottic closure and loss of normal glottic valving function predispose to air loss and may account for dyspnea. 4…”

mentioning

confidence: 99%

“…Kashima proposed that a paralyzed, flaccid vocal fold can be drawn into the air stream during respiration, resulting in turbulence and effectively decreased airflow 3 . The lack of glottic closure and loss of normal glottic valving function predispose to air loss and may account for dyspnea 4 …”

mentioning

confidence: 99%

“…3 The lack of glottic closure and loss of normal glottic valving function predispose to air loss and may account for dyspnea. 4 There is some controversy regarding the impact of medialization on flow dynamics and perception of dyspnea. Decreased peak inspiratory flow and development of new extrathoracic obstruction on flow-volume loop have been observed on pulmonary function tests after thyroplasty.…”

mentioning

confidence: 99%

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Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Hoffman

Vandiver

Derise

et al. 2021

Otolaryngol.--head neck surg.

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Objective Patients with unilateral vocal fold paralysis commonly report dysphonia and dysphagia. Dyspnea also occurs, with studies on treatment-related change producing mixed results. Studies including patient-reported outcomes have focused on single-question global scales. The Dyspnea Index (DI) includes 10 questions, is specific to upper airway–related dyspnea, and may better capture these patients’ symptoms. We evaluated change in DI after treatment. Study Design Retrospective review. Setting Academic medical center. Methods Forty-three patients with unilateral vocal fold paralysis underwent injection augmentation (n = 25) or framework surgery (n = 18). DI was recorded preprocedure, 2 to 4 weeks afterward, and at approximately 3 months afterward in 19 patients. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 were also recorded. Change in parameters and correlations were assessed. Obesity, cardiac disease, pulmonary disease, and procedure (injection vs framework surgery) were evaluated for effect on DI. Results Twenty-four patients had an abnormal baseline DI (>10). DI decreased from 14.9 ± 13.8 to 6.5 ± 9.3 after treatment ( P < .001; 95% CI, 4.7-12.1). Twenty-eight scores decreased, 9 remained unchanged, and 6 increased. Change in DI was influenced by the presence of cardiac disease. Decreased DI persisted at 3-month follow-up. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 scores decreased and were correlated with change in DI. Conclusion Upper airway–related dyspnea is common in unilateral vocal fold paralysis, occurring in half of this cohort. Correcting glottic insufficiency may alleviate symptoms. Treatment decision making should consider postprocedural change in dyspnea, especially in patients for whom dyspnea is a motivating factor for seeking treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…3 The lack of glottic closure and loss of normal glottic valving function predispose to air loss and may account for dyspnea. 4…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%