Predicting the Outcome of Unilateral Vocal Fold Paralysis: A Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10

Objectives: The aim of this study was to investigate if any clinical and phoniatric characteristics or quality-of-life measures could predict the outcome of unilateral vocal fold paralysis (UVFP) initially managed with speech therapy. Methods: Forty-six patients with UVFP were evaluated using laryngostroboscopy, the GIRBAS (grade, instability, roughness, breathiness, asthenia, and strain) scale, acoustic analysis, and the Voice Handicap Index-10 (VHI-10) questionnaire. Treatment was speech therapy according to a 3-phase protocol. The main outcome measure was incomplete vocal fold mobility 12 months after symptom onset. Univariate and multivariate modeling ( k-nearest neighbors model) were applied. Results: Fifteen patients had incomplete motion recovery 12 months after the onset of UVFP. On univariate analysis, time to diagnosis (0.01), global grade of dysphonia (0.018), jitter (0.01), shimmer (0.012), and VHI-10 score (0.006) were associated with the outcome of vocal fold paralysis. Using a k-nearest neighbors multivariate discriminating model, the best discrimination of UVFP outcome was achieved with 4 parameters: global grade of dysphonia 2 or 3, jitter > 2.46%, shimmer > 6.97%, and VHI-10 score > 13. The model’s misclassification rate for incomplete motion recovery was only 6%. The model showed sensitivity of 93% and specificity of 74%. Conclusions: Delayed diagnosis and speech therapy was associated with negative outcomes. Higher grade of dysphonia, jitter, shimmer, and VHI-10 score on initial phoniatric assessment may help clinicians in predicting the outcomes of UVFP patients.

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Characteristics of the Voice Handicap Index for Patients With Unilateral Vocal Fold Paralysis Who Underwent Arytenoid Adduction

Journal of Voice ◽

10.1016/j.jvoice.2018.12.012 ◽

2020 ◽

Vol 34 (4) ◽

pp. 649.e1-649.e6 ◽

Cited By ~ 1

Author(s):

Kenichi Watanabe ◽

Takeshi Sato ◽

Yohei Honkura ◽

Ai Kawamoto-Hirano ◽

Kazutaka Kashima ◽

...

Keyword(s):

Vocal Fold ◽

Vocal Fold Paralysis ◽

Voice Handicap Index ◽

Unilateral Vocal Fold Paralysis ◽

Arytenoid Adduction ◽

The Voice

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215100132980 ◽

1996 ◽

Vol 110 (2) ◽

pp. 141-143 ◽

Cited By ~ 15

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.

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Vocal fold paresis – a debilitating and underdiagnosed condition

The Journal of Laryngology & Otology ◽

10.1017/s0022215117000810 ◽

2017 ◽

Vol 131 (S2) ◽

pp. S48-S52 ◽

Cited By ~ 7

Author(s):

G Harris ◽

C O'Meara ◽

C Pemberton ◽

J Rough ◽

P Darveniza ◽

...

Keyword(s):

Quality Of Life ◽

Vocal Fold ◽

Speech Therapy ◽

Clinical Signs ◽

Vocal Fold Paralysis ◽

Voice Handicap Index ◽

Laryngeal Electromyography ◽

Vocal Fold Paresis ◽

Important Diagnostic Tool

AbstractObjectives:To review the clinical signs of vocal fold paresis on laryngeal videostroboscopy, to quantify its impact on patients’ quality of life and to confirm the benefit of laryngeal electromyography in its diagnosis.Methods:Twenty-nine vocal fold paresis patients were referred for laryngeal electromyography. Voice Handicap Index 10 results were compared to 43 patients diagnosed with vocal fold paralysis. Laryngeal videostroboscopy analysis was conducted to determine side of paresis.Results:Blinded laryngeal electromyography confirmed vocal fold paresis in 92.6 per cent of cases, with vocal fold lag being the most common diagnostic sign. The laryngology team accurately predicted side of paresis in 76 per cent of cases. Total Voice Handicap Index 10 responses were not significantly different between vocal fold paralysis and vocal fold paresis groups (26.08 ± 0.21 and 22.93 ± 0.17, respectively).Conclusion:Vocal fold paresis has a significant impact on quality of life. This study shows that laryngeal electromyography is an important diagnostic tool. Patients with persisting dysphonia and apparently normal vocal fold movement, who fail to respond to appropriate speech therapy, should be investigated for a diagnosis of vocal fold paresis.

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Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Otolaryngology ◽

10.1177/01945998211056515 ◽

2021 ◽

pp. 019459982110565

Author(s):

Matthew R. Hoffman ◽

Beau Vandiver ◽

Natalie Derise ◽

Edie R. Hapner ◽

Glen Leverson ◽

...

Keyword(s):

Cardiac Disease ◽

Vocal Fold ◽

Assessment Tool ◽

Upper Airway ◽

Severity Index ◽

Vocal Fold Paralysis ◽

Voice Handicap Index ◽

Unilateral Vocal Fold Paralysis ◽

Function Index ◽

Patient Reported

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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Maximum vocal intensity as a primary outcome measure in unilateral vocal fold paralysis patients

The Journal of Laryngology & Otology ◽

10.1017/s0022215120002558 ◽

2020 ◽

pp. 1-9

Author(s):

S F Johari ◽

M Azman ◽

A S Mohamed ◽

M M Baki

Keyword(s):

Vocal Fold ◽

Primary Outcome ◽

Outcome Measure ◽

Vocal Fold Paralysis ◽

Voice Handicap Index ◽

Injection Laryngoplasty ◽

Unilateral Vocal Fold Paralysis ◽

Post Intervention ◽

Surgical Interventions ◽

Vocal Intensity

Abstract Objective To evaluate voice intensity as the primary outcome measurement when treating unilateral vocal fold paralysis patients. Methods This prospective observational study comprised 34 newly diagnosed unilateral vocal fold paralysis patients undergoing surgical interventions: injection laryngoplasty or medialisation thyroplasty. Voice assessments, including maximum vocal intensity and other acoustic parameters, were performed at baseline and at one and three months post-intervention. Maximum vocal intensity was also repeated within two weeks before any surgical interventions were performed. The results were compared between different time points and between the two intervention groups. Results Maximum vocal intensity showed high internal consistency. Statistically significant improvements were seen in maximum vocal intensity, Voice Handicap Index-10 and other acoustic analyses at one and three months post-intervention. A significant moderate negative correlation was demonstrated between maximum vocal intensity and Voice Handicap Index-10, shimmer and jitter. There were no significant differences in voice outcomes between injection laryngoplasty and medialisation thyroplasty patients at any time point. Conclusion Maximum vocal intensity can be applied as a treatment outcome measure in unilateral vocal fold paralysis patients; it can demonstrate the effectiveness of treatment and moderately correlates with self-reported outcome measures.

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