Summary
Aim
Steps for assessment and successful management of bilateral vocal fold motion impairment
(VFMI) are (1) recognition of its presence, (2) identifying the etiology and factors
restricting vocal fold motion, (3) evaluation of airway patency, and (4) establishing
a management plan. No large series documenting the course and outcome of adult idiopathic
bilateral VFMI has been published within the past 15 years.
Methods
Retrospective chart review of adult patients with idiopathic bilateral VFMI at a tertiary
academic center. A diagnosis was established if history, physical examination with
laryngoscopy, and initial imaging excluded a cause. Records were reviewed for demographics,
clinical characteristics, surgical intervention details, and length of follow-up.
Results
Nine adult patients with idiopathic bilateral VFMI were identified. There were five
males and four females with a mean age of 59.6 years. The mean follow-up period was
54.4 months (range, 6–111 months). Upon presentation to our laryngology service, three
patients were advised observation, three patients were advised to undergo urgent tracheostomy,
and three patients were advised to undergo elective surgery for airway management.
By the end of the follow-up period, only four patients (4/9, 44.4%) were tracheostomy
dependent, one of them was lost to follow-up after tracheostomy tub downsizing for
decannulation.
Conclusions
To our best knowledge, this is the largest series so far of adult patients with idiopathic
bilateral VFMI. Conservative treatment can be considered as an alternative to surgery
in select cases.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Current treatment options for bilateral vocal fold paralysis: a state-of-the-art review.Clin. Exp. Otorhinolaryngol. 2017; 10: 203-212
- Surgical management of bilateral immobile vocal folds and long-term follow-up.J. Laryngol. Otol. 1997; 111: 474-477
- Idiopathic bilateral vocal fold weakness.Laryngoscope. 1999; 109: 995-1002
- Idiopathic vocal fold paralysis: clinical course and outcomes.J. Neurol. Sci. 2009; 284: 56-62
- Nomenclature proposal to describe vocal fold motion impairment.Eur. Arch. Oto-Rhino-Laryngology. 2016; 273: 1995-1999
- Vocal cord paralysis. A review of 100 cases.Laryngoscope. 1970; 80: 1036-1045
- The aetiology of bilateral recurrent laryngeal nerve paralysis.Med. J. Aust. 1973; 2: 776-777
- Etiology of bilateral abductor vocal cord paralysis.Ann. Otol. Rhinol. Laryngol. 1976; 85: 428-436
- The evolving etiology of bilateral vocal fold immobility.J. Voice. 2003; 17: 76-81
- Vocal fold immobility: a longitudinal analysis of etiology over 20 years.Laryngoscope. 2007; 117: 1864-1870
- Changing etiology of vocal fold immobility.Laryngoscope. 1998; 108: 1346-1350
- Idiopathic vocal cord palsies and associated neurological conditions.Arch. Otolaryngol – Head. Neck. Surg. 2005; 131: 1086-1089
- Diagnostic testing for vocal fold paralysis: survey of practice and evidence-based medicine review.Laryngoscope. 2006; 116: 1539-1552
- Diagnostic yield of computed tomography in the evaluation of idiopathic vocal fold paresis.Otolaryngol. Neck. Surg. 2015; 153: 414-419
- Repeat imaging in idiopathic unilateral vocal fold paralysis.Ann. Otol. Rhinol. Laryngol. 2016; 125: 1010-1014
- Evaluation and management of bilateral vocal cord immobility.Otolaryngol. Neck. Surg. 1999; 121: 760-765
- Clinical practice guideline: hoarseness (Dysphonia) (Update).Otolaryngol. Neck. Surg. 2018; 158: S1-S42
- Laryngoscopy of vocal fold paralysis: evaluation of consistency of clinical findings.Laryngoscope. 2010; 120: 1376-1382
- Office-based arytenoid palpation for diagnosis of disorders of bilateral vocal fold immobility.Ear. Nose. Throat. J. 2006; 85: 520-522
- Unilateral vocal cord paralysis: a review of CT findings, mediastinal causes, and the course of the recurrent laryngeal nerves.RadioGraphics. 2012; 32: 721-740
- Usefulness of computed tomography in the etiologic evaluation of adult unilateral vocal fold paralysis.World. J. Surg. 2013; 37: 1236-1240
- Cost-effectiveness of routine computed tomography in the evaluation of idiopathic unilateral vocal fold paralysis.Laryngoscope. 2017; 127: 440-444
- Laboratory evaluation of vocal fold paralysis and paresis.J. Voice. 2017; 31: 168-174
- Evaluation of peripheral vocal cord paralysis by electromyography.Laryngoscope. 2008; 118: 987-990
- Laryngeal electromyography for prognosis of vocal fold palsy: a meta-analysis.Laryngoscope. 2012; 122: 158-161
- Consensus statement: Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis.Muscle. Nerve. 2016; 53: 850-855
- Time course of recovery of idiopathic vocal fold paralysis.Laryngoscope. 2018; 128: 148-152
- Permanent transoral surgery of bilateral vocal fold paralysis: A prospective multi-center trial.Laryngoscope. 2015; 125: 1401-1408
- Tracheostomy: epidemiology, indications, timing, technique, and outcomes.Respir. Care. 2014; 59: 895-919
- Effects of tracheostomy on well-being and body-image perceptions.Otolaryngol. Neck. Surg. 2005; 133: 366-371
- Quality of life and self-image in patients undergoing tracheostomy.Laryngoscope. 2010; 120: S196
- A systematic review of patient and caregiver experiences with a tracheostomy.Patient. 2017; 11: 175-191
- Laterofixation of the vocal fold using an endo-extralaryngeal needle carrier for bilateral vocal fold paralysis.Auris. Nasus. Larynx. 2009; 36: 181-186
- Surgery of adult bilateral vocal fold paralysis in adduction: history and trends.Eur. Arch Oto-Rhino-Laryngology. 2008; 265: 1501-1514
- Laryngeal reinnervation for bilateral vocal fold paralysis.Curr. Opin. Otolaryngol. Head. Neck. Surg. 2011; 19: 434-438
- Laryngeal pacing for bilateral vocal fold immobility.Curr. Opin. Otolaryngol. Head. Neck. Surg. 2011; 19: 439-443
- Botulinum toxin injections for new onset bilateral vocal fold motion impairment in adults.Laryngoscope. 2010; 120: 758-763
- The role of botulinum toxin in the management of airway compromise due to bilateral vocal fold paralysis.Curr. Opin. Otolaryngol. Head. Neck. Surg. 2011; 19: 444-448
- Dysfunction of the recurrent laryngeal nerve and the potential of gene therapy.Ann Otol Rhinol Laryngol. 2007; 116: 441-448
- Injection of autologous muscle stem cells (myoblasts) for the treatment of vocal fold paralysis: a pilot study.Laryngoscope. 2007; 117: 917-922
Article info
Publication history
Published online: December 04, 2018
Accepted:
November 21,
2018
Identification
Copyright
© 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
