Unilateral True Vocal Fold Synkinesis Presenting with Airway Obstruction

Objectives We present a case series of 10 patients with unilateral true vocal fold paralysis who presented with airway obstruction. Methods A retrospective review of the authors' patients at 2 institutions with unilateral true vocal fold motion impairment was carried out over a 10-year period. Of these, 10 patients were identified who presented with stridor and dyspnea as a result of synkinesis. Six cases were a result of thyroidectomy, 1 case resulted from recurrent laryngeal nerve section for spasmodic dysphonia, 1 case occurred after anterior cervical diskectomy and fusion, and in 2 cases no cause was identified. Results Three patients underwent tracheotomy. Two patients underwent partial arytenoidectomy. Seven patients underwent botulinum toxin injection; 2 were treated with breathing therapy, and in 1 case breathing therapy was recommended. Seven patients underwent treatment with more than 1 method. Conclusions Unilateral vocal fold paralysis may present with airway obstruction as a result of synkinesis. Treatment should be incremental and starts with breathing therapy and botulinum toxin injection. Partial arytenoidectomy or tracheotomy may be necessary for refractory cases.

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Vocal fold botulinum toxin injection for refractory paradoxical vocal fold motion disorder

The Laryngoscope ◽

10.1002/lary.27471 ◽

2018 ◽

Vol 129 (4) ◽

pp. 808-811 ◽

Cited By ~ 2

Author(s):

Brad deSilva ◽

Drew Crenshaw ◽

Laura Matrka ◽

L. Arick Forrest

Keyword(s):

Botulinum Toxin ◽

Vocal Fold ◽

Botulinum Toxin Injection ◽

Vocal Fold Motion ◽

Paradoxical Vocal Fold Motion

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Airway obstruction due to unilateral vocal fold paralysis

The Laryngoscope ◽

10.1002/lary.23719 ◽

2013 ◽

Vol 123 (4) ◽

pp. 969-974 ◽

Cited By ~ 11

Author(s):

Jennifer L. Nelson ◽

Gayle E. Woodson

Keyword(s):

Airway Obstruction ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Unilateral Vocal Fold Paralysis

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Association between Upper Respiratory Infection and Idiopathic Unilateral Vocal Fold Paralysis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418787542 ◽

2018 ◽

Vol 127 (10) ◽

pp. 667-671 ◽

Cited By ~ 4

Author(s):

Neel K. Bhatt ◽

Patrik Pipkorn ◽

Randal C. Paniello

Keyword(s):

Respiratory Infection ◽

Vocal Fold ◽

Case Series ◽

Vocal Fold Paralysis ◽

Unilateral Vocal Fold Paralysis ◽

Viral Etiology ◽

Upper Respiratory Infection ◽

Future Studies ◽

Presenting Symptoms ◽

Upper Respiratory

Introduction: Unilateral vocal fold paralysis (UVFP) without an identifiable cause is termed idiopathic unilateral vocal fold paralysis (IUVFP). Some authors have postulated that select cases of IUVFP have a viral etiology, but the causality has not been established. We set out to review institutional cases of IUVFP and determine if there is a correlation between upper respiratory infection symptoms and presentation of IUVFP. Methods: Cases of IUVFP were reviewed over a 10-year period (2002-2012). The history was investigated to review presenting symptoms. We specifically reviewed for symptoms of upper respiratory infection at the onset of UVFP and tallied the frequency. Symptoms included sore throat, laryngitis, cough, influenza, bronchitis, pneumonia, otalgia, and sinusitis. The seasonal onset (if possible) was determined based on the history provided from the initial consultation. Study Design: Case series. Results: Overall, 107 patients presented with IUVFP; 35.5% of patients reported symptoms of upper respiratory infection at the onset of UVFP. Among these individuals, pharyngitis/laryngitis was the most common presenting symptom; 34.2% reported cough. In total, 40.0% of patients with IUVFP reported an onset of symptoms between December and February. Conclusions: This study suggests that symptoms of upper respiratory infection frequently occur with the presentation of IUVFP. The onset of symptoms tended to occur between December and February. The mechanism of viral-mediated UVFP has not been established. Future studies to explore this pathophysiology are needed.

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Botulinum toxin injection in the treatment of vocal fold paralysis associated with multiple sclerosis: A case report

Journal of Voice ◽

10.1016/s0892-1997(99)80032-0 ◽

1999 ◽

Vol 13 (2) ◽

pp. 274-279 ◽

Cited By ~ 15

Author(s):

Eugene Rontal ◽

Michael Rontal ◽

John Wald ◽

David Rontal

Keyword(s):

Multiple Sclerosis ◽

Case Report ◽

Botulinum Toxin ◽

Vocal Fold ◽

Botulinum Toxin Injection ◽

Vocal Fold Paralysis

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Novel Approach of Medialization Thyroplasty with Arytenoid Adduction Performed under General Anesthesia with a Laryngeal Mask

Otolaryngology ◽

10.1177/0194599811427811 ◽

2011 ◽

Vol 146 (2) ◽

pp. 266-271 ◽

Cited By ~ 13

Author(s):

Nicholas W. Stow ◽

Jennifer W. Lee ◽

Ian E. Cole

Keyword(s):

Vocal Fold ◽

Case Series ◽

Vocal Fold Paralysis ◽

Laryngeal Mask ◽

Unilateral Vocal Fold Paralysis ◽

Maximum Phonation Time ◽

Arytenoid Adduction ◽

Medialization Thyroplasty ◽

The Voice

Objective. To objectively assess the voice outcomes of patients with unilateral vocal fold paralysis treated with medialization thyroplasty and arytenoid adduction suture. Study Design. Case series of patients who underwent medialization thyroplasty and arytenoid adduction suture. Preoperative and postoperative voice testing was performed and the data were compared by statistical analysis. Setting. Tertiary referral teaching hospital in Sydney, Australia. Subjects. All patients had a unilateral vocal fold paralysis, with a large posterior glottic gap and vocal symptoms affecting their quality of life. Methods. Thirteen patients with a diagnosis of a unilateral vocal fold paralysis with a large posterior glottic gap, vocal symptoms, and total denervation of the vocal fold underwent medialization thyroplasty and arytenoid adduction suture. The surgery was performed in a novel method under a general anesthetic using a laryngeal mask and with direct intraoperative endoscopic feedback. Preoperative and postoperative measures of voice performance were compared, including acoustic analysis (fundamental frequency, speech intensity against quiet and loud background noise, speech rate) and aerodynamic assessment (airflow, maximum phonation time). Results. Medialization thyroplasty with arytenoid adduction suture significantly improved aerodynamic assessment and phonation duration for both male and female subjects overall. There were 2 of 13 treatment failures. Median follow-up time was 6 months. Conclusion. Preliminary results indicate that in selected patients with vocal fold paralysis, medialization thyroplasty with arytenoid adduction suture leads to significant improvements in objective voice measures. Longer follow-up data are required to further quantify the voice outcomes after this procedure.

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