Vocal fold paresis: Medical specialists’ opinions on standard diagnostics and laryngeal findings

Volk, Gerd Fabian; Themel, Sebastian; Gugatschka, Markus; Pototschnig, C; Sittel, Christian; Müller, Andréas; Guntinas‐Lichius, Orlando; Surgery, Neck

doi:10.1007/s00405-018-5102-5

Cited by 14 publications

(12 citation statements)

References 20 publications

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“…According to Wu et al [9], only 1.7% of the otolaryngologists responded to use LEMG for the diagnosis of vocal fold paresis (VFP) in the US. Similar result was also presented for Europe by Volk et al [10], with only 3.6% of the responding that LEMG is the most important tool for diagnosing VFP. This may be due to the lack of agreement on methodology, interpretation, validity, and clinical application of LEMG when using LEMG [11–16].…”

Section: Introductionsupporting

confidence: 86%

“…VFP accounts for an important part of clinical workload in an ENT department. In a university department in Germany, Austria and Switzerland VFP was diagnosed eight times per month, which emphasizes the magnitude of the problem in clinical routine [10]. Wu and Sulica also reported the exact same prevalence for US American laryngology experts [9].…”

Section: Discussionmentioning

confidence: 95%

“…Although LEMG is the best tool for diagnosing laryngeal paresis objectively and possesses a high predictive value for the outcome of VFP with poor prognosis, many laryngologists still do not routinely used it. The causes might be lacking of agreement on methodology, interpretation, validity and clinical application of LEMG [10].…”

Section: Discussionmentioning

confidence: 99%

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Inter-rater reliability of seven neurolaryngologists in laryngeal EMG signal interpretation

Leonhard

Volk

et al. 2019

Eur Arch Otorhinolaryngol

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PurposeLaryngeal electromyography (LEMG) has been considered as gold standard in diagnostics of vocal fold movement impairment, but is still not commonly implemented in clinical routine. Since the signal interpretation of LEMG signals (LEMGs) is often a subjective and semi-quantitative matter, the goal of this study was to evaluate the inter-rater reliability of neurolaryngologists on LEMGs of volitional muscle activity.MethodsFor this study, 52 representative LEMGs of 371 LEMG datasets were selected from a multicenter registry for a blinded evaluation by 7 experienced members of the neurolaryngology working group of the European Laryngological Society (ELS). For the measurement of the observer agreement between two raters, Cohen’s Kappa statistic was calculated. For the interpretation of agreements of diagnoses among the seven examiners, we used the Fleiss’ Kappa statistic.ResultWhen focusing on the categories “no activity”, “single fiber pattern”, and “strongly decreased recruitment pattern”, the inter-rater agreement varied from Cohen’s Kappa values between 0.48 and 0.84, indicating moderate to near-perfect agreement between the rater pairs. Calculating with Fleiss’ Kappa, a value of 0.61 showed good agreement among the seven raters. For the rating categories, the Fleiss’ Kappa value ranged from 0.52 to 0.74, which also showed a good agreement.ConclusionA good inter-rater agreement between the participating neurolaryngologists was achieved in the interpretation of LEMGs. More instructional courses should be offered to broadly implement LEMG as a reliable diagnostic tool in evaluating vocal fold movement disorders in clinical routine and to develop future algorithms for therapy and computer-assisted examination.

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Section: Introductionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 95%

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Inter-rater reliability of seven neurolaryngologists in laryngeal EMG signal interpretation

Leonhard

Volk

et al. 2019

Eur Arch Otorhinolaryngol

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“…The final analysis of both retrospective and prospective data should help us to better understand the problems linked to the standardization of diagnosis, treatment and follow-up of BVFP patients and point out the best outcome measures to improve and make the decision making more consistent across the hospitals and countries [3]. The standardization of the evaluation of BVFP treatments would also help defining the outcome measures according to which new approaches, such as like reinnervation surgery or laryngeal pacing should be compared to.…”

Section: Discussionmentioning

confidence: 99%

Therapy of bilateral vocal fold paralysis: Real world data of an international multi-center registry

et al. 2019

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Purpose To collect data on diagnosis, treatment, patient’s management, and quality of life in patient with bilateral vocal fold paralysis (BVFP). Methods A retrospective, observational, multicenter registry study was performed. Medical records of 326 adults with permanent BVFP (median age: 61 years; 70% female, 60% after thyroid surgery) generated between 2010 and 2017. Results Median time between BVFP onset and inclusion was 1.2 years. Median post-treatment follow-up was 2 months (range: 0–42). Surgery was treatment of choice in 61.7% of the cases, with a 2-year revision rate of 32.4%. Prior to inclusion, 40.2% of the patients underwent at least one surgery. For tracheotomized patients, decannulation rate was 33.8%. Non-surgical treatments included voice therapy and botulinum toxin injection. Corticosteroid application was the most frequent treatment for post-treatment complications (18%; 1-month after surgery). Older age was an independent predictor for dyspnea (Hazard ratio [HR] = 1.041; CI = 1.005 to 1.079; p = 0.026) and the need for oxygen treatment (HR = 1.098; CI = 1.009 to 1.196; p = 0.031). Current alcohol consumption (HR = 2.565; CI = 1.232 to 5.342; p = 0.012) and a cancer-related etiology (HR = 4.767; CI = 1.615 to 14.067; p = 0.005) were independent factors of higher revision risk. Conclusions Surgery for BVFP is currently not standardized but highly variable. Postoperative and BVFP-related complications and revision surgery are frequent. Complications are linked to patients’ alcohol drinking habits and BVFP etiology. These results shall be confirmed by the upcoming evaluation of the prospective data of this registry.

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“…Nevertheless, so far LEMG has still been rarely used in diagnostics of UVFP [ 17 , 18 ]. In the USA and Western Europe only a quite low percentage of the otolaryngologists, 1.7% and 3.6%, respectively, use LEMG for diagnostics and estimating prognosis in UVFP/bilateral vocal fold paralysis (BVFP) [ 17 , 18 ]. Arguments in favor of LS are easier feasibility, availability, and less discomfort for the patient during the examination compared to LEMG.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic limitation of laryngostroboscopy in comparison to laryngeal electromyography in synkinesis in unilateral vocal fold paralysis

Stanisz

Leonhard

Denk-Linnert

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose In clinical practice, laryngo(strobo)scopy (LS) is still mainly used for diagnostics and management of unilateral vocal fold paralysis (UFVP), although only laryngeal electromyography (LEMG) can provide information on causes of vocal fold immobility, especially on possible synkinetic reinnervation after recurrent laryngeal nerve (RLN) injury. The goal of this retrospective study was the evaluation whether signs of synkinetic reinnervation in LS can be objectified in comparison to LEMG data. Methods Between 1/2015 and 2/2018, 50 patients with laryngostroboscopically suspected UVFP received routine LEMG examination. The LEMG findings were retrospectively compared with LS findings. The LEMG data analysis focused on the diagnosis of synkinetic reinnervation of the TA/LCA and/or PCA. The digital LS recordings were retrospectively re-evaluated by phoniatricians considering 22 selected laryngostroboscopic parameters. Results LEMG revealed synkinesis in 23 (46%) and absence of synkinesis in 27 (54%) patients. None of the 22 parameters showed significant association between patients with synkinetic reinnervation and LS findings. The only laryngostroboscopic parameter that was significantly associated with a silent LEMG signal compared to single fiber activity in LEMG was a length difference on the side of the UVFP (p-value 0.0001; OR 14.5 (95% CI 3.047–66.81; Sensitivity 0.5; Specificity 0.9355). Conclusion Our findings show that synkinesis cannot be diagnosed using only LS. This study underlines the importance of LEMG in clinical routine for detection of laryngeal synkinesis in patients with UVFP before any further therapeutic steps are initiated to avoid later therapy failure.

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Vocal fold paresis: Medical specialists’ opinions on standard diagnostics and laryngeal findings

Abstract: The laryngology experts in Europe rely on LEMG for diagnosis of VFP like the US American experts, but paradoxically only a minority uses LEMG frequently. Next to LEMG, motion abnormities were considered to have the best predictive value for the diagnosis of VFP.

Cited by 14 publications

References 20 publications

Inter-rater reliability of seven neurolaryngologists in laryngeal EMG signal interpretation

Inter-rater reliability of seven neurolaryngologists in laryngeal EMG signal interpretation

Therapy of bilateral vocal fold paralysis: Real world data of an international multi-center registry

Diagnostic limitation of laryngostroboscopy in comparison to laryngeal electromyography in synkinesis in unilateral vocal fold paralysis

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