Our study aimed to both identify the incidence and clinical presentation of patients presenting with idiopathic vocal fold paralysis (IVFP). Secondarily we aimed to assess the radiographic findings of computed tomography (CT) studies along the course of the vagus and recurrent laryngeal nerves (RLN), specifically measuring for potential areas of compression at the skull base and mediastinum. We hypothesized that a proportion of patients diagnosed with IVFP would have significant differences in measurements when compared to age-gender matched controls on CT imaging.
Institutional review board approved retrospective cohort study
We assessed patients presenting to a tertiary voice care center between 2003 and 2019 with diagnosis of vocal fold paralysis. Data collected includes demographics, clinical exam findings, and CT measurements including dimensions at bilateral jugular foramen, aortopulmonary (AP) window and surrounding vascular structures. Statistical analysis was then performed using Pearson χ2, and Mann Whitney U tests to determine differences variables of interest.
A total of 606 patients were reviewed. Of these patients 60 (9.9%) patients were determined to have IVFP. Left-sided VFP was seen more commonly in 78.3% (N = 47) of idiopathic patients. Our IVFP group had an overall higher incidence of cardiovascular disease [OR = 3.378, 95%CI 1.907-5.941, P < 0.001] compared to those with identified causes for paralysis. Specifically, IVFP patients showed a higher incidence of combined cardiovascular co-morbidities (P < 0.001), mitral valve stenosis (P = 0.007), pulmonary hypertension (P < 0.0001) and congestive heart failure (P < 0.001). When evaluating CT imaging, the AP window was mentioned in only 2 (3.3%) of our idiopathic patients CT reports. The IVFP cohort had a lower median AP window volume (P = 0.020) when compared to age-gender matched controls. This significantly smaller AP window volume was also seen when only left sided IVFP compared to both right-sided paralysis (P < 0.001) and age matched control patients (P < 0.001).
The significance of cardiovascular comorbidities combined with findings of statistically narrowed AP window may help provide an explanation of a subset of patients diagnosed with IVFP.
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 access
One-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 Voice
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Voice disorders in the general population: prevalence, risk factors, and occupational impact.Laryngoscope. 2005; 115: 1988-1995
- Hoarseness-causes and treatments.Deutsches Arzteblatt Int. 2015; 112: 329-337
- Unilateral vocal cord paralysis: a review of CT findings, mediastinal causes, and the course of the recurrent laryngeal nerves.RadioGraphics. 2012; 32: 721-740
- Life experience of patients with unilateral vocal fold paralysis.JAMA Otolaryngol Head Neck Surg. 2018; 144: 433-439
- Vocal cord paralysis and its etiologies: a prospective study.J Cardiovasc Thorac Res. 2014; 6: 47-50
- Vocal cord paralysis as a sign of chest diseases: 15-year retrospective study.World J Surg. 2006; 30: 293-298
- Thyroid carcinoma invading the upper aerodigestive system.Laryngoscope. 1990; 100: 824-830
- Diagnostic testing for vocal fold paralysis: survey of practice and evidence-based medicine review.Laryngoscope. 2006; 116: 1539-1552
- Herpes simplex virus in idiopathic facial paralysis (Bell palsy).JAMA. 1975; 233: 527-530
- Idiopathic vocal fold paralysis: clinical course and outcomes.J Neurol Sci. 2009; 284: 56-62
- Recurrenslahmung bei mitral stenose.Wein Klin Wochenschr. 1897; 10: 753-755
- Cardio-vocal syndrome laryngeal paralysis in intrinsic heart disease.Am Heart J. 1958; 56: 51-59
- Cardiovocal syndrome: a systematic review.Heart, Lung and Circulation. 2008; 17: 1-4
- Extracranial internal carotid artery tortuosity may cause vocal cord palsy.Acta Oto-Laryngologica. 2019; 139: 304-308
- A computations study of the role of the aortic arch in idiopathic unilateral vocal-fold paralysis.J App Physiol. 2015; 118: 465-474
- Aortic arch compliance and idiopathic unilateral vocal cord paralysis.J Appl Physiol. 2017; 123: 303-309
- Evidence-based practice: evaluation and management of unilateral vocal fold paralysis.Otolaryngol Clin North Am. 2012; 45: 1083-1108
- Usefulness of computed tomography in the etiologic evaluation of adult unilateral vocal cord paralysis.World J Surg. 2013; 37: 1236-1240
- Patient-reported problems associated with dysphonia.Clin Otolaryngol Allied Sci. 1997; 22: 37-40
- The quality of life impact of dysphonia.Clin Otolaryngol Allied Sci. 2002; 27: 179-182
- What is your understanding of your illness? A communication tool to explore patients' perspectives of living with advanced illness.J Gen Intern Med. 2012; 27: 1460-1466
- Idiopathic unilateral vocal-fold paralysis in the adult.Otorhinolaryngol Head Neck Dis. 2018; 135: 171-174
- Association between upper respiratory infection and idiopathic unilateral vocal fold paralysis.Ann Otol Rhinol Laryngol. 2018; 127: 667-671
- Ortner’s syndrome: a case report and review of the literature.BMJ Case Rep. 2014; 2014 (https://casereports.bmj.com/content/2014/bcr-2013-202900)bcr2013202900
- Reversible cardiovocal (Ortner's) syndrome in dilated cardiomyopathy- a rare presentation of a common disease.J Assoc Physicians India. 2020; 68: 65-66
- Reis. giant cell arteritis with aortic involvement leading to cardio vocal syndrome (Ortner's Syndrome).Arquivos Brasileiros de Cardiologia. 2020; 114: 16-18
- Cardiovocal syndrome secondary to an aortic aneurysm.Case Rep Otolaryngol. 2016; (Published 2016 March 20. https://doi.org/10.1155/2016/9867942)9867942
- The incidence and recovery rate of idiopathic vocal fold paralysis: a population-based study.Eur Arch Otorhinolaryngol. 2019; 276: 153-158
- The anatomical explanation of the paralysis of the left recurrent laryngeal nerve found in certain cases of mitral stenosis.Amer Jour Med Sci. 1911; 141: 625-638
- Idiopathic unilateral vocal fold paralysis in older patients: characteristics in the disease course and implication of computed tomography for evaluation of etiology.Ann Otol Rhinol Laryngol. 2018; 127: 823-828
- Imaging modalities in the etiologic evaluation of unilateral vocal fold paralysis.J Voice. 2019; 33: 813.e1-813.e5
Published online: December 22, 2020
Accepted: November 27, 2020
Declarations of interest: None.
© 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.