Myasthenia gravis mimicking unilateral vocal fold paralysis at presentation

2006 ◽  
Vol 121 (2) ◽  
pp. 174-178 ◽  
Author(s):  
D M Hartl ◽  
S Leboulleux ◽  
P Klap ◽  
M Schlumberger
Keyword(s):  
Myasthenia Gravis ◽  
Vocal Fold ◽  
Current Knowledge ◽  
Voice Quality ◽  
Vocal Folds ◽  
Flexible Endoscopy ◽  
Clinical Analysis ◽  
Vocal Fold Paralysis ◽  
Motor Deficits ◽  
Unilateral Vocal Fold Paralysis

Objectives: To demonstrate the importance of detailed clinical analysis in the differential diagnosis of unilateral vocal fold paralysis, and to provide an update on current knowledge and treatment of myasthenia gravis.Case report: A female patient presented with left unilateral vocal fold immobility. Diagnostic investigation revealed a 10 mm thyroid adenoma, but no other abnormality likely to cause unilateral vocal fold paralysis. Follow-up flexible endoscopy at three months showed laryngeal remobilisation with persistent left vocal fold bowing and vertical asymmetry of the vocal folds on phonation. Over the following months, voice quality varied between normal and breathy, with the breathy periods lasting from three days to one month. Laryngeal electromyography (EMG) showed a slight bilateral paradoxical activation of both posterior crico-arytenoid muscles on phonation. Magnetic resonance imaging of the brain and brainstem was normal. A diagnostic test for myasthenia gravis with intravenous edrophonium bromide (Tensilon®) lead to an immediate improvement in voice quality. The patient was subsequently treated with pyridostigmine bromide, with complete resolution of dysphonia.Conclusions: Myasthenia gravis affecting the larynx may mimic unilateral vocal fold paresis or paralysis. A personal or family history of auto-immune disease, fluctuating symptoms, motor deficits in cranial nerve territories, and normal or subnormal laryngeal EMG results should lead the physician to reconsider a diagnosis of idiopathic unilateral vocal fold paralysis and to perform specific testing.

scholarly journals Using Innovative Acoustic Analysis to Predict the Postoperative Outcomes of Unilateral Vocal Fold Paralysis

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Yung-An Tsou ◽  
Yi-Wen Liu ◽  
Wen-Dien Chang ◽  
Wei-Chen Chen ◽  
Hsiang-Chun Ke ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Linear Prediction ◽  
Acoustic Analysis ◽  
Characteristic Curve ◽  
Voice Quality ◽  
Treatment Strategies ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Outcome Predictor ◽  
Laryngeal Framework Surgery

Objective.Autologous fat injection laryngoplasty is ineffective for some patients with iatrogenic vocal fold paralysis, and additional laryngeal framework surgery is often required. An acoustically measurable outcome predictor for lipoinjection laryngoplasty would assist phonosurgeons in formulating treatment strategies.Methods.Seventeen thyroid surgery patients with unilateral vocal fold paralysis participated in this study. All subjects underwent lipoinjection laryngoplasty to treat postsurgery vocal hoarseness. After treatment, patients were assigned to success and failure groups on the basis of voice improvement. Linear prediction analysis was used to construct a new voice quality indicator, the number of irregular peaks (NIrrP). It compared with the measures used in the Multi-Dimensional Voice Program (MDVP), such as jitter (frequency perturbation) and shimmer (perturbation of amplitude).Results.By comparing the [i] vowel produced by patients before the lipoinjection laryngoplasty (AUC = 0.98, 95% CI = 0.78–0.99), NIrrP was shown to be a more accurate predictor of long-term surgical outcomes than jitter (AUC = 0.73, 95% CI = 0.47–0.91) and shimmer (AUC = 0.63, 95% CI = 0.37–0.85), as identified by the receiver operating characteristic curve.Conclusions.NIrrP measured using the LP model could be a more accurate outcome predictor than the parameters used in the MDVP.

scholarly journals Injection laryngoplasty as miniinvasive office-based surgery in patients with unilateral vocal fold paralysis – voice quality outcomes

2017 ◽  
Vol 3 ◽  
pp. 277-284 ◽  
Author(s):  
Ewelina M. Sielska-Badurek ◽  
Maria Sobol ◽  
Katarzyna Jędra ◽  
Anna Rzepakowska ◽  
Ewa Osuch-Wójcikiewicz ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Injection Laryngoplasty ◽  
Unilateral Vocal Fold Paralysis ◽  
Quality Outcomes

Vocal Evaluation of Thyroplasty Type I in the Treatment of Nonparalytic Glottic Incompetence

1998 ◽  
Vol 107 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Fang-Ling Lu ◽  
Donna S. Lundy ◽  
Roy R. Casiano ◽  
Jun-Wu Xue
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Perceptual Judgment ◽  
Function Evaluation ◽  
Type I ◽  
Unilateral Vocal Fold Paralysis ◽  
Vocal Function ◽  
Voice Outcome ◽  
Minimal Improvement

This study investigated the prethyroplasty and postthyroplasty voices of patients with glottic incompetence of mobile vocal folds related to vocal fold bowing and scarring. Seventeen patients underwent vocal function evaluation preoperatively and 1 month postoperatively with videostrobolaryngoscopic examination, acoustic and aerodynamic analysis, and perceptual judgment of voice characteristics. The postoperative voice outcome in this group of patients was compared to that of a group of patients with unilateral vocal fold paralysis. Patients with vocal fold bowing showed significant improvement in glottic gap size and hoarseness after the surgery. There was minimal improvement on other test measures. Patients with vocal fold scarring exhibited worse preoperative and postoperative vocal functions, with little voice improvement after surgery. The outcome of thyroplasty type I in cases of vocal fold bowing or scarring is not as good as that in unilateral vocal fold paralysis.

The role of stroboscopy in the management of a patient with a unilateral vocal fold paralysis

1996 ◽  
Vol 110 (2) ◽  
pp. 141-143 ◽  
Author(s):  
Meredydd Lloyd Harries ◽  
Murray Morrison
Keyword(s):  
Surgical Treatment ◽  
Diagnostic Tool ◽  
Vocal Fold ◽  
Speech Therapy ◽  
Muscle Tone ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis

AbstractStroboscopy is well established as an essential diagnostic tool in the assessment of the vocal folds during phonation. This paper analyses the stroboscopic findings in 100 patients with a unilateral vocal fold paralysis. Reliable stroboscopic signals were only obtained in patients with the paralysed fold close to the midline. These patients seldom require surgery however, usually responding to speech therapy with laryngeal compensation giving a good voice. Most patients that require surgery have a large glottal deficiency, but in this series these patients did not give an adequate signal for analysis. Although useful in the assessment of the muscle tone of the paralysed fold, the influence of stroboscopy on the surgical treatment in this series was limited.

Objective Voice Quality Analysis Before and After Onset of Unilateral Vocal Fold Paralysis

2001 ◽  
Vol 15 (3) ◽  
pp. 351-361 ◽  
Author(s):  
Dana M Hartl ◽  
Stéphane Hans ◽  
Jaqueline Vaissière ◽  
Marc Riquet ◽  
Daniel F Brasnu
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Quality Analysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Before And After

Results of Fascial Augmentation in Unilateral Vocal Fold Paralysis

2002 ◽  
Vol 111 (6) ◽  
pp. 523-529 ◽  
Author(s):  
Petri Reijonen ◽  
Sari Lehikoinen-Söderlund ◽  
Heikki Rihkanen
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Inexpensive Method ◽  
Maximum Phonation Time ◽  
Perceptual Evaluation

The objective of this study was to evaluate the effects on voice quality of augmentation by injection of minced fascia in patients with unilateral vocal fold paralysis. Preoperative and postoperative voice samples from 14 patients (6 men and 8 women; mean age, 59 years) were analyzed by computerized acoustic analysis and blinded perceptual evaluation. Statistically significant improvements were seen in perturbation measurements (jitter and shimmer), noise-to-harmonics ratio, and maximum phonation time. A panel of evaluators rated 10 of the 14 postoperative voices as normal or near-normal. Injection laryngoplasty with minced fascia offers a new, effective, well-tolerated, and inexpensive method to medialize a paralyzed vocal fold. The graft seems to survive well, as indicated by good vocal results with a follow-up ranging from 5 to 32 months.

Hoarseness due to Mycobacterium kansasii

2008 ◽  
Vol 123 (5) ◽  
pp. 569-571 ◽  
Author(s):  
D Wray ◽  
M O Oko ◽  
D A R Boldy ◽  
M T Butt
Keyword(s):  
Weight Loss ◽  
World Literature ◽  
Vocal Fold ◽  
Sputum Sample ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Mycobacterium Kansasii ◽  
Unilateral Vocal Fold Paralysis ◽  
Abnormal Chest ◽  
History Of

AbstractObjective:To present a case of unilateral vocal fold paralysis due to Mycobacterium kansasii induced pressure on the left recurrent laryngeal nerve, a specific aetiology not previously reported in the world literature.Case report:A 57-year-old Caucasian man presented with a short history of productive cough, fever, hoarseness and 14-kg weight loss. He was a smoker, had an abnormal chest X-ray and was human immunodeficiency virus negative. A sputum sample was positive on direct microscopy for acid fast bacilli. Initially, the patient was treated with Rifater (rifampicin, isoniazid and pyrazinamide) and ethambutol. Mycobacterium kansasii was isolated and proved sensitive to this antimycobacterial treatment. Nasoendoscopy revealed diminished movement of the left vocal fold, and a computed tomography scan showed enlarged mediastinal lymph nodes anterior to the aortic arch. After three months of antimycobacterial treatment, the vocal folds were fully mobile at repeat nasoendoscopy, and this coincided with gradual resolution of the patient's hoarseness and weight loss.Conclusions:There are many causes of unilateral vocal fold paralysis. This case illustrates the importance of anatomical knowledge in reaching a diagnosis, and also presents the first reported case of Mycobacterium kansasii creating this clinical picture.

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