Vocal Fold Paresis 2020
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NEUROLARYNGOLOGY (AJ MCWHORTER AND L ADKINS, SECTION EDITORS)
Vocal Fold Paresis 2020 Keith Chadwick 1
&
Lucian Sulica 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Although the clinical significance of vocal fold paresis is generally acknowledged among specialists, details of evaluation and diagnosis remain highly debated. Recent Findings Many studies evaluating vocal fold paresis have been performed in the last two decades; most are retrospective and fraught with methodological concerns. Diagnosis and management of paresis remain founded primarily on experience and opinion with little high-quality evidence to support clinical practice. Summary Universally agreed-upon standards for diagnosis remain elusive. Most laryngologists diagnose paresis by laryngoscopic or stroboscopic signs, despite acknowledged interrater inconsistencies. Laryngeal electromyography has the potential to be a valuable diagnostic adjunct, although not immune to similar concerns regarding interpretation. Diagnostic treatment trials offer a practical means to verify clinical impression. Treatment options are similar to those in vocal fold paralysis. Otolaryngologists should remain vigilant to identify paresis at the same time that they remain wary of casual overdiagnosis. Keywords Vocal fold paresis . Laryngeal neuropathy . Glottic insufficiency . Dysphonia . Laryngeal electromyography . Stroboscopy
Introduction
This article is part of the Topical collection on Neurolaryngology
laryngoscopic observation of laryngeal motion asymmetry, remains under debate. How is one to distinguish an innocent laryngeal asymmetry from vocal fold paresis, and, if paresis is present, how can one be sure that it is relevant to the patient’s complaint? It is not too much of an exaggeration to say that a dogmatic examiner may find signs of paresis in every larynx, much like laryngopharyngeal reflux. Because this fundamental question remains unsettled, high level evidence does not exist. Most literature is retrospective, with variable standards and criteria for diagnosis, leading to a lack of consensus about the clinical impact of vocal fold paresis. A critical approach based on an understanding of the pathophysiology of laryngeal neuropathy is needed if we are to avoid vocal fold paresis becoming a “one-size-fits-all” explanation for complaints that we cannot easily explain otherwise; again, laryngopharyngeal reflux provides the cautionary tale.
* Keith Chadwick [email protected]
Etiology and Incidence
Since this subject was last reviewed in 2013 [1], the notion that neurogenic laryngeal dysfunction occurs on a continuum, and that even mild neuropathy may be clinically significant, has gained broad currency among laryngologists, if not the general otolaryngology community. This has been accompanied by an expanding appreciation that paresis, or partial paralysis, may not be limited to motor nerves, but may also involve sensory nerves to contribute to such symptoms as globus, cough, pain, and laryngo
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