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Journal of Voice
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    • Bilateral Vocal Fold Immobility Disorders

    Article Type

    • Research Article15
    • Review Article2
    • Case Reports1

    Publication Date

    Author

    • Rosen, Clark A2
    • Witt, Robert L2
    • Aino, Iichirou1
    • Andrade Filho, Pedro A1
    • Baker, Susan E1
    • Benninger, Michael S1
    • Bohr, Christopher1
    • Chen, Xuejun1
    • Ciftci, Halide Gunes1
    • Ciftci, Zafer1
    • Coffey, Charles S1
    • Cooper, Timothy1
    • Davenport, Paul1
    • Deniz, Mahmut1
    • Dziegielewski, Peter T1
    • Döllinger, Michael1
    • Eysholdt, Ulrich1
    • Farrar, Emily K1
    • Feehery, John M1
    • Fukuo, Akira1
    • Gibbins, Nicholas1
    • Gnagi, Sharon H1
    • Gultekin, Erdogan1
    • Halstead, Lucinda A1
    • Hamoir, Marc1

    Journal

    • Journal of Voice18

    Keyword

    • Bilateral vocal fold paralysis5
    • Vocal fold immobility5
    • Bilateral vocal fold immobility3
    • Sarcoidosis3
    • Larynx2
    • Acromegaly1
    • Adjustment procedure1
    • Airway1
    • Anastomosis of Galen1
    • Arytenoid cartilage1
    • Arytenoidectomy1
    • Bilateral abductor vocal fold paralysis1
    • Bilateral recurrent laryngeal nerve paralysis1
    • Bilateral vocal fold abductor paralysis1
    • Bilateral vocal fold palsy1
    • Botox1
    • Botulinum toxin1
    • Chondrosarcoma1
    • CO2 laser1
    • Corticosteroids1
    • Creutzfeldt-Jacob disease1
    • Cricothyroid muscle injection1
    • Diagnosis1
    • Dyspnea1
    • Electromyographic examination1

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    • Open Access
    Journal of Voice Source Readings

    Bilateral Vocal Fold Immobility Disorders

    Karen M Kost

    This collection contains 18 articles pertaining to Bilateral Vocal Fold Immobility (BVFI). Most of the papers deal with the etiology and treatment of BVFI.

    The more common causes of BVFI are addressed in a review article in 2003 (1), in which the authors point out evolving trends. Most cases are caused by malignancies and nonsurgical trauma, followed by iatrogenic causes such as thyroid surgery. There are several interesting reports detailing unusual etiologies of BVFI, including intubation, sarcoidosis, acromegaly, Creutzfeld-Jacob disease and laryngeal chondrosarcoma.

    Many of the articles relating to management focus on surgical options intended to allow for decannulation, a good airway, a serviceable voice, and safe degluttition. Endoscopic posterior cordotomy/cordectomy is discussed, either alone or in combination with some form of arytenoidectomy. Endoscopic suture lateralization also has been proposed as a procedure which allows for adjustments and is ultimately reversible. Laryngeal reinnervation has been suggested as a means of treatment, although it is not yet used commonly. Botulinum toxin injection into the thyroarytenoid or cricothyroid muscles has been described, achieving sufficient vocal fold abduction to produce decannulation. These injections may be used as a temporizing solution until a more permanent intervention is planned, or they may be repeated regularly for maintenance of effect.

    In summary, this collection provides interesting insights into the etiology and treatment of BVFI offering an appreciation of possible future directions.

     

    References

    1. Feehery JM, Pribitkin EA, Heffelfinger RN, Lacombe VG, Lee D, Lowry LD, et al. The evolving etiology of bilateral vocal fold immobility. J Voice. 2003;17(1):76-81
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    • Research Article

      Sarcoidosis Presenting as Bilateral Vocal Fold Immobility

      Journal of Voice
      Vol. 32Issue 3p359–362Published online: July 3, 2017
      • Justin M. Hintze
      • Sharon H. Gnagi
      • David G. Lott
      Cited in Scopus: 4
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        Bilateral true vocal fold paralysis is rarely attributable to inflammatory diseases. Sarcoidosis is a rare but important etiology of bilateral true vocal fold paralysis by compressive lymphadenopathy, granulomatous infiltration, and neural involvement. We describe the first reported case of sarcoidosis presenting as bilateral vocal fold immobility caused by direct fixation by granulomatous infiltration severe enough to necessitate tracheostomy insertion. In addition, we discuss the presentation, the pathophysiology, and the treatment of this disease with a review of the literature of previously reported cases of sarcoidosis-related vocal fold immobility.
        Sarcoidosis Presenting as Bilateral Vocal Fold Immobility
      • Research Article

        Transcricothyroid Endoscopic Subglottic Surgery for Posterior Glottic Stenosis: A Case Report

        Journal of Voice
        Vol. 31Issue 5p634–637Published online: March 18, 2017
        • Koji Matsushima
        • Kentaro Matsuura
        • Teppei Takeda
        • Yuko Sasaki
        • Akira Fukuo
        • Kota Wada
        • and others
        Cited in Scopus: 1
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          Posterior glottic stenosis (PGS) is a rare but life-threatening condition mostly caused by damage to the interarytenoid mucosa by an endotracheal tube. In surgical treatment of PGS, airway patency is prioritized, and the laryngeal functions involved in swallowing and phonation are considerably sacrificed. In the majority of cases, lateralization of a vocal fold or partial excision of a vocal fold and arytenoid cartilage results in glottal closure insufficiency and deterioration of phonatory function.
          Transcricothyroid Endoscopic Subglottic Surgery for Posterior Glottic Stenosis: A Case Report
        • Research Article

          Evaluation of Vocal Fold Motion Abnormalities: Are We All Seeing the Same Thing?

          Journal of Voice
          Vol. 31Issue 1p72–77Published online: November 2, 2016
          • Lyndsay L. Madden
          • Clark A. Rosen
          Cited in Scopus: 9
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            Flexible laryngoscopy is the principle tool for the evaluation of vocal fold motion. As of yet, no consistent, unified outcome metric has been developed for vocal fold paralysis/immobility research. The goal of this study was to evaluate vocal fold motion assessment (inter- and intra-rater reliability) among general otolaryngologists and fellowship-trained laryngologists.
            Evaluation of Vocal Fold Motion Abnormalities: Are We All Seeing the Same Thing?
          • Review Article

            Acromegaly Presenting With Bilateral Vocal Fold Immobility: Case Report and Review of the Literature

            Journal of Voice
            Vol. 30Issue 6p758.e13–758.e16Published online: October 6, 2015
            • Timothy Cooper
            • Peter T. Dziegielewski
            • Praby Singh
            • Robert Seemann
            Cited in Scopus: 2
            Online Extra
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              To present a case of bilateral vocal fold immobility (BVCI) in a patient with acromegaly and review the current literature describing this presentation.
              Acromegaly Presenting With Bilateral Vocal Fold Immobility: Case Report and Review of the Literature
            • Research Article

              Magnetic Control of the Glottic Opening in an Ex Vivo Sheep Larynx Model: A Preliminary Study

              Journal of Voice
              Vol. 30Issue 5p621–625Published online: August 4, 2015
              • Zafer Ciftci
              • Mahmut Deniz
              • Halide Gunes Ciftci
              • Damla Nihan Ozdemir
              • Aklime Isik
              • Erdogan Gultekin
              Cited in Scopus: 2
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                So far, a number of techniques have been described for the treatment of bilateral vocal fold paralysis. These techniques were reported to be successful in maintaining an adequate airway but also found to be associated with an increased risk of aspiration, dysphonia, and granulation tissue formation at the operation site. We aimed to investigate the effectiveness of a novel mucosa-sparing technique based on the generation of a magnetic field within the larynx for the tailored lateralization of the ipsilateral vocal fold.
                Magnetic Control of the Glottic Opening in an Ex Vivo Sheep Larynx Model: A Preliminary Study
              • Case Reports

                Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series

                Journal of Voice
                Vol. 30Issue 1p96–99Published online: March 24, 2015
                • Michael S. Benninger
                • Andrea Hanick
                • Douglas M. Hicks
                Cited in Scopus: 10
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                  Bilateral vocal fold paralysis most commonly results from iatrogenic trauma to the recurrent laryngeal nerve during surgical procedures in the anterior neck. Patients may require tracheostomy because of acute or gradual onset of dyspnea and airway compromise. The intralaryngeal injection of Botox has been considered as a possible therapy for these airway symptoms of bilateral vocal fold paralysis. Chronic unopposed activity of intact cricothyroid muscles could potentially result in gradual medialization of the vocal folds in patients with bilateral recurrent laryngeal nerve paralysis.
                  Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series
                • Review Article

                  The Evolution of Laryngeal Reinnervation, the Current State of Science and Thoughts for Future Treatments

                  Journal of Voice
                  Vol. 28Issue 6p793–798Published online: April 15, 2014
                  • Nicholas Gibbins
                  Cited in Scopus: 4
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                    The treatment of unilateral vocal fold palsy (UVFP) or bilateral vocal fold palsy (BVFP) has been the subject of debate and experiment for 150 years. To date, dozens of different surgical methods have been described to reinnervate this most complex of organs, the larynx. As yet, there is no consensus on the most functionally effective method of reinnervation. However, it is a rapidly expanding area of research and remains an area of controversy. Indications for reinnervation for both UVFP and BVFP are still evolving and our understanding of the neuromuscular supply to the larynx continues to expand.
                    The Evolution of Laryngeal Reinnervation, the Current State of Science and Thoughts for Future Treatments
                  • Research Article

                    Suture Lateralization in Patients With Bilateral Vocal Fold Paralysis

                    Journal of Voice
                    Vol. 28Issue 5p644–651Published online: March 14, 2014
                    • Wan-Fu Su
                    • Shao-Cheng Liu
                    • Wei-Sheng Tang
                    • Mei-Chen Yang
                    • Yuan-Yung Lin
                    • Tung-Tsun Huang
                    Cited in Scopus: 15
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                      To introduce a simplified suture lateralization (SL) technique to treat patients with bilateral vocal fold paralysis (BVFP).
                      Suture Lateralization in Patients With Bilateral Vocal Fold Paralysis
                    • Research Article

                      Laryngeal Chondrosarcoma of the Arytenoid Cartilage Presenting as Bilateral Vocal Fold Immobility: A Case Report and Literature Review

                      Journal of Voice
                      Vol. 28Issue 1p129.e13–129.e17Published online: October 4, 2013
                      • Rong Hu
                      • Wen Xu
                      • Honggang Liu
                      • Xuejun Chen
                      Cited in Scopus: 8
                      Online Extra
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                        To describe an atypical case of laryngeal chondrosarcoma of arytenoid cartilage presenting as bilateral vocal fold immobility and to avoid potential missed diagnosis.
                        Laryngeal Chondrosarcoma of the Arytenoid Cartilage Presenting as Bilateral Vocal Fold Immobility: A Case Report and Literature Review
                      • Research Article

                        Multiparametric Analysis of Vocal Fold Vibrations in Healthy and Disordered Voices in High-Speed Imaging

                        Journal of Voice
                        Vol. 25Issue 5p576–590Published online: August 23, 2010
                        • Elisabeth C. Inwald
                        • Michael Döllinger
                        • Maria Schuster
                        • Ulrich Eysholdt
                        • Christopher Bohr
                        Cited in Scopus: 82
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                          The aim of this study was to look for visual subjective and objective parameters of vocal fold dynamics being capable of differentiating healthy from pathologic voices in daily clinical practice applying endoscopic high-speed digital imaging (HSI).
                          Multiparametric Analysis of Vocal Fold Vibrations in Healthy and Disordered Voices in High-Speed Imaging
                        • Research Article

                          Sarcoidosis Presenting as Bilateral Vocal Cord Paralysis From Bilateral Compression of the Recurrent Laryngeal Nerves From Thoracic Adenopathy

                          Journal of Voice
                          Vol. 23Issue 5p631–634Published online: May 13, 2008
                          • Charles S. Coffey
                          • Stacey L. Vallejo
                          • Emily K. Farrar
                          • Marc A. Judson
                          • Lucinda A. Halstead
                          Cited in Scopus: 15
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                            Bilateral true vocal fold paralysis is rarely attributable to inflammatory diseases. We describe what appears to be the first case in the medical literature of sarcoidosis presenting as isolated, bilateral true vocal cord paralysis resulting from compressive bilateral mediastinal adenopathy. The presenting symptoms, clinical outcome, radiographs and laryngeal findings are discussed in detail. Sarcoidosis should therefore be added to the differential diagnosis of bilateral vocal fold paralysis.
                            Sarcoidosis Presenting as Bilateral Vocal Cord Paralysis From Bilateral Compression of the Recurrent Laryngeal Nerves From Thoracic Adenopathy
                          • Research Article

                            A Case of Creutzfeldt-Jacob Disease with Bilateral Vocal Fold Abductor Paralysis

                            Journal of Voice
                            Vol. 23Issue 5p635–638Published online: May 13, 2008
                            • Lishu Li
                            • Hideto Saigusa
                            • Hiroshi Nagayama
                            • Tsuyoshi Nakamura
                            • Iichirou Aino
                            • Taro Komachi
                            • and others
                            Cited in Scopus: 3
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                              Bilateral vocal fold abductor paralysis was seen in a patient with Creutzfeldt-Jacob disease. After tracheotomy, the patient showed disappearance of reduced oxygen saturation with high-pitched inspiratory stridor and pulling phenomenon of the supraclavicular region and larynx. Electromyographic examinations of the intrinsic laryngeal muscles, including the thyroarytenoid and posterior cricoarytenoid muscles, demonstrated that there was no apparent action potential in those muscles during spontaneous respiratory movements, and there was no abnormal potential for those muscles at rest.
                              A Case of Creutzfeldt-Jacob Disease with Bilateral Vocal Fold Abductor Paralysis
                            • Research Article

                              Bilateral vocal fold paralysis: an unsual treatment with botulinum toxin

                              Journal of Voice
                              Vol. 18Issue 2p254–255Published in issue: June, 2004
                              • Pedro A. Andrade Filho
                              • Clark A. Rosen
                              Cited in Scopus: 15
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                                We presented a patient with bilateral vocal fold paralysis treated with intralaryngeal Botox injection to improve the glottal airway. The use of Botox in this manner has not been previously reported and highlights the value and role of intralaryngeal Botox in changing the configuration of the glottis. The concept and various approaches for using Botox to alter pathologic vocal fold position is reviewed and discussed.
                                Bilateral vocal fold paralysis: an unsual treatment with botulinum toxin
                              • Research Article

                                Electrophysiologic monitoring of the recurrent laryngeal nerves may not predict bilateral vocal fold immobility after thyroid surgery

                                Journal of Voice
                                Vol. 18Issue 2p256–260Published in issue: June, 2004
                                • Robert L. Witt
                                Cited in Scopus: 6
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                                  Two cases of bilateral vocal fold immobility (VFI) after identification and preservation of the recurrent laryngeal nerves (RLNs) required tracheotomy until vocal fold recovery. The first patient underwent thyroid surgery without preoperative or postoperative evaluation of the vocal folds, administration of postoperative intravenous steroids, or electrophysiologic monitoring of the RLNs, whereas the second patient underwent a thyroid procedure in which all of the aforementioned were executed. Preoperative and postoperative clinical evaluation of the RLNs is strongly suggested in patients undergoing thyroid surgery, especially revision surgery.
                                • Original article

                                  Inspiratory pressure threshold training for upper airway limitation: a case of bilateral abductor vocal fold paralysis

                                  Journal of Voice
                                  Vol. 17Issue 3p384–394Published in issue: September, 2003
                                  • Susan E Baker
                                  • Christine M Sapienza
                                  • Danny Martin
                                  • Paul Davenport
                                  • Bari Hoffman-Ruddy
                                  • Gayle Woodson
                                  Cited in Scopus: 25
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                                    Summary: A single subject design was used to determine if pressure threshold training strengthens the inspiratory muscles in a subject with a limited glottal airway as well as diminish dyspnea and improve parameters of speech. The subject was a 19-year-old woman whose glottal airway was limited due to bilateral abductor vocal fold paralysis following a thyroidectomy. A 5-week inspiratory muscle strength-training program was implemented using a pressure-threshold trainer to strengthen the inspiratory muscles with the intent of enabling the generation of higher inspiratory pressures.
                                    Inspiratory pressure threshold training for upper airway limitation: a case of bilateral abductor vocal fold paralysis
                                  • Original article

                                    Sarcoidosis Presenting as Bilateral Vocal Fold Paralysis

                                    Journal of Voice
                                    Vol. 17Issue 2p265–268Published in issue: June, 2003
                                    • Robert L Witt
                                    Cited in Scopus: 12
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                                      Summary: Sarcoidosis with cranial polyneuritis and mediastinal granulomatous compression as a cause of unilateral left vocal fold paralysis has been reported infrequently. No case of sarcoidosis causing bilateral vocal fold paralysis in the abducted position has been reported in the Otolaryngology/Voice literature. Vocal fold function can be impacted in sarcoidosis by direct laryngeal involvement or by neural pathways. In the patient described in this case, sarcoid cranial polyneuritis coupled with bilateral paratracheal and mediastinal adenopathy resulted in bilateral vocal fold paralysis.
                                      Sarcoidosis Presenting as Bilateral Vocal Fold Paralysis
                                    • Research Article

                                      The Evolving Etiology of Bilateral Vocal Fold Immobility

                                      Journal of Voice
                                      Vol. 17Issue 1p76–81Published in issue: March, 2003
                                      • John M Feehery
                                      • Edmund A Pribitkin
                                      • Ryan N Heffelfinger
                                      • Victor G Lacombe
                                      • Daniel Lee
                                      • Louis D Lowry
                                      • and others
                                      Cited in Scopus: 41
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                                        Summary: In the past, bilateral vocal fold immobility (BVFI) occurred most commonly after thyroidectomy. However, no large series documenting the etiology of adult BVFI has been published within the past fifteen years. This study reviews the etiologic patterns of BVFI at our institutions. We compare BVFI from before and after 1980. We also review combined studies of unilateral vocal fold immobility (UVFI) to compare and unilateral versus bilateral etiologic trends. In comparison with previously published series, fewer cases of BVFI present today as a complication of thyroid surgery and more as the result of malignancies and nonsurgical trauma.
                                        The Evolving Etiology of Bilateral Vocal Fold Immobility
                                      • Research Article

                                        Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: Functional results

                                        Journal of Voice
                                        Vol. 10Issue 3p314–319Published in issue: 1996
                                        • Georges Lawson
                                        • Marc Remacle
                                        • Marc Hamoir
                                        • Jacques Jamart
                                        Cited in Scopus: 29
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                                          We report vocal and respiratory results following endoscopic CO2 laser therapy for bilateral vocal fold immobility in adduction. Two techniques were used: posterior cordectomy (PC) and subtotal arytenoidectomy (SA). Respiratory improvement was demonstrated by the peak expiratory flow/peak inspiratory flow ratio (PEF/PIF, normal = 1), which was less than 2 for 83% of patients following PC and for 81% following SA. As for vocal results, there were no significant quantitative differences between the two techniques.
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