Vocal Cord Paralysis

What are the most common causes of vocal fold paralysis?

Reference(s):

Spataro, E. A., Grindler, D. J., & Paniello, R. C. (2014). Etiology and Time to Presentation of Unilateral Vocal Fold Paralysis. Otolaryngology–Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 151(2), 286–293.

A patient is referred from your favorite thoracic surgeon for hoarseness after aortic aneurysm repair. On exam, you find an immobile vocal fold. How can you determine the etiology?

Why do patients with vocal fold immobility experience dysphagia?

Reference(s):

Domer, A. S., Leonard, R., & Belafsky, P. C. (2014). Pharyngeal weakness and upper esophageal sphincter opening in patients with unilateral vocal fold immobility. The Laryngoscope, 124(10), 2371–2374.

What type of workup is needed for unilateral vocal fold paresis?

Reference(s):

Badia, P. I., Hillel, A. T., Shah, M. D., Johns, M. M. 3rd, & Klein, A. M. (2013). Computed tomography has low yield in the evaluation of idiopathic unilateral true vocal fold paresis. The Laryngoscope, 123(1), 204–207.

Describe the controversy with vocal cord position in vocal cord paralysis.

Can otolaryngologists reliably identify vocal fold paresis?

Reference(s):

Sufyan, A. S., Kincaid, J. C., Wannemuehler, T. J., & Halum, S. L. (2013). The interarytenoid spatial relationship: accuracy and interrater reliability for  determining sidedness in cases of unilateral adductor paresis. Journal of Voice : Official Journal of the Voice Foundation, 27(1), 90–94.

Medialization thyroplasty-discuss the indications.

Reference(s):

Bielamowicz S. (2004).Medialization thyroplasty-indications, advantages. Perspectives on medialization laryngoplasty. Otolaryngol Clin North Am, 37(1), 139-60.

Is medialization thyroplasty just for vocal cord paralysis?

Shah, R.N., Deal, A.M., Buckmire, R.A. (2013). Multidimensional voice outcomes after type 1 Gore-Tex throplasty in patients with nonparalytic glottic incompetence: a subgroup analysis. Laryngoscope, 123(7), 1742-5.

Vocal fold injectional medialization vs. intrachordal injection. What is the difference? Outcomes?

Unilateral vocal fold medialization by injection: transcutaneous vs laryngoscopic, Discuss indications and advantages for each?

What materials are available for injection medialization?

Reference(s):

Lakhani, R., Fishman, J. M., Bleach, N., Costello, D., & Birchall, M. (2012). Alternative injectable materials for vocal fold medialization in unilateral vocal fold paralysis. The Cochrane Database of Systematic Reviews, 10, CD009239.

Discuss the management of over injection during vocal fold medialization.

Discuss the 4 types of open thyroplasty procedures. What would you use for implant?

While rarely used today, teflon has been used in the past for injection medializations. Discuss the formation of Teflon granulomas, their presentation, and management options.

What is the goal of arytenoid adduction? What clinical situations do you think Indicate a need for this procedure? How do you do an arytenoid adduction?

Would you perform an arytenoid adduction without medialization procedure?

Reference(s):

Mortensen, M., Carroll, L., & Woo, P. (2009). Arytenoid adduction with medialization laryngoplasty versus injection or medialization laryngoplasty: the role of the arytenoidopexy. The Laryngoscope, 119(4), 827–831.

What is the success of reinnervation procedures? When is it a good option?

A patient is found to have bilateral vocal fold immobility in a midline position. The patient refuses tracheostomy. What issues determine your options in care? Discuss short-term treatments for bilateral vocal cord paralysis.

Discuss long-term treatments for bilateral vocal cord paralysis.

Reference(s):

Young, V. N., & Rosen, C. A. (2011). Arytenoid and posterior vocal fold surgery for bilateral vocal fold immobility. Current Opinion in Otolaryngology & Head and Neck Surgery, 19(6), 422–427.