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Laryngoscope 2021 Apr 2. Epub 2021 Apr 2.

Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria.

Objective: Selective electrical surface stimulation (SES) of the larynx is not yet routinely considered therapy option in treatment of unilateral vocal fold paralysis (UVFP). Goal of this monocentric feasibility study was to provide systematic data on applicability of SES of intrinsic laryngeal muscles in UVFP under consideration of sensitivity and discomfort thresholds and nonselective side effects.

Methods: Thirty-two UVFP patients were included in the study. Read More

BMJ Case Rep 2021 Mar 15;14(3). Epub 2021 Mar 15.

Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

A 67-year-old man presented with progressive diplopia. On evaluation, he was noted to have bilateral palsies of cranial nerves III, IV and VI as well as a unilateral right true vocal fold paralysis. CT and MRI studies demonstrated a T2-bright left ethmoid mass with no evidence of bony erosion. Read More

Laryngoscope 2021 Feb 12. Epub 2021 Feb 12.

Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A.

Objectives/hypothesis: Glottic stenosis is a discrete cause of airway compromise. We aimed to determine the surgical outcomes of transverse cordotomy with anteromedial arytenoidectomy (TCAMA), performed in the setting of isolated glottic stenosis resulting from two discrete etiologies: bilateral vocal fold paralysis (BVFP) and posterior glottic stenosis (PGS).

Study Design: Retrospective, analytic cohort study. Read More

Rev Esp Anestesiol Reanim 2020 Dec 26. Epub 2020 Dec 26.

Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, España. Electronic address:

Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. Read More

Medicine (Baltimore) 2021 Jan;100(3):e24374

Department of Orthopedics, Zhangqiu People's Hospital, Jinan.

Rationale: Vocal fold paralysis and cauda equina syndrome are very rare neurologic deficits. This report describes the case of a patient who simultaneously developed both after uneventful spinal-epidural anesthesia with 0.5% hyperbaric bupivacaine. Read More

BMJ Case Rep 2021 Feb 4;14(2). Epub 2021 Feb 4.

ENT, Ulster Hospital, Belfast, UK.

A 72-year-old man initially presented to the ENT outpatient department after 20 years with increasing intermittent episodes of dyspnoea and stridor. Flexible nasendoscopy revealed bilateral vocal cord paralysis with the cords in a medial position. He subsequently underwent urgent tracheostomy. Read More

Ann Otol Rhinol Laryngol 2021 Apr 27;130(4):405-415. Epub 2021 Jan 27.

Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.

Objective: Chemotherapy-induced vocal fold motion impairment (CIVFMI) is a rare complication of cancer therapy with potential for airway compromise. The objective of this review is to present 2 new cases of CIVFMI to add to the literature as well as characterize the demographics, symptoms, exam findings, airway complication rates and prognosis of CIVFMI.

Methods: A search of Pubmed/MEDLINE (1970 to May 1, 2020), Embase (1970 to May 1, 2020), and Cochrane Library using medical study heading (MeSH) terms related to chemotherapy () and vocal cord motion impairment (, ) was performed. Read More

J Voice 2021 Jan 16. Epub 2021 Jan 16.

State Center in Rehabilitation and Readaptation Dr. Henrique Santillo - CRER, Goiânia, Goiás State, Brazil.

Introduction: Bilateral vocal fold paralysis is a condition accounting for great mortality and significant worsening in patients' quality of life. Treatment applied to these patients seek balance among breathing, airway protection and voice quality.

Aim: Critically and systematically reviewing the current literature on the topic in order to set the best technique to restore breathing comfort, without the need of tracheostomy, in patients with bilateral vocal fold paralysis. Read More

Auris Nasus Larynx 2021 Jan 13. Epub 2021 Jan 13.

Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, People's Republic of China. Electronic address:

Objective: To evaluate the contribution of amplitude reduction compared vagal stimulation at the end of thyroid dissection (V2) to the most distal RLN stimulation during thyroidectomy in predicting postoperative vocal cords paralysis (VCP).

Methods: Patients with intact preoperative RLN function who underwent monitored thyroidectomy between August 2017 and April 2018 were included. We routinely tested the exposed RLN at the lowest proximal end (R2p signal) and the most distal end near the laryngeal entry point (R2d signal), and then routinely detected the vagal nerve at the horizontal plane of the inferior pole of thyroid with 2mA stimulation current. Read More

BMJ Case Rep 2021 Jan 12;14(1). Epub 2021 Jan 12.

Neurophysiology, Hertford County Hospital, Hertford, UK.

A previously fit and well 53-year-old man was referred to the otolaryngology clinic with intermittent stridor and was found to have bilateral vocal fold paresis. Subsequent airway compromise necessitated emergency surgical tracheostomy. The man was discharged home with tracheostomy in situ and a diagnosis of idiopathic bilateral vocal cord palsy, as all primary investigations were negative. Read More

Eur Arch Otorhinolaryngol 2021 Mar 3;278(3):839-841. Epub 2021 Jan 3.

Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg.

Introduction: Spasmodic dysphonia (SD), a form of focal dystonia, has been defined as a neurogenic, task-specific disorder characterized by abrupt spasms of intrinsic laryngeal muscles that result in phonatory breaks. There are three classic types of SD: adductor SD, abductor (ABSD) and mixed SD. Compared with the more common adductor form, treatment of ABSD with botulinum toxin injection is related to a shorter efficacy and improvement in only about 70% of patients [Blitzer et al. Read More

J Voice 2020 Dec 22. Epub 2020 Dec 22.

Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas.

Objective: 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. Read More

Case Rep Otolaryngol 2020 12;2020:8822164. Epub 2020 Nov 12.

Department of Otorhinolaryngology & Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan.

Background: Endolaryngeal suture lateralisation is an ideal operation for bilateral vocal fold paralysis. However, restenosis owing to breakage and slippage of suture can sometimes occur. In such a case, methods that are more effective in expanding the glottis, including arytenoidectomy, must be selected. Read More

Eur Arch Otorhinolaryngol 2021 Apr 27;278(4):1145-1151. Epub 2020 Nov 27.

Department of Otorhinolaryngology, Faculty of Medicine, Kafrelsheikh University, El-Giesh Street, Kafrelsheikh, 33155, Egypt.

Purpose: This study aims to assess the role of diode laser-assisted posterior cordectomy with partial arytenoidectomy in the management of bilateral vocal fold paralysis patients.

Methods: Posterior cordectomy with partial arytenoidectomy using diode laser was performed to thirty-nine patients with bilateral vocal fold paralysis. Voice was evaluated by maximal phonation time and Arabic version of the voice handicap index, while breathing difficulty was assessed by mMRC (Modified Medical Research Council) dyspnea scale. Read More

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020 Nov;55(11):1080-1085

Department of Otorhinolaryngology Head and Neck Surgery, the Sixth Medical Center of Chinese People's Liberation Army General Hospital, College of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100048, China.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020 Nov;55(11):1022-1026

The Sixth Medical Center of Chinese People's Liberation Army General Hospital, College of Otolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Beijing 100048, China.

To evaluate the efficacy of the endoscopic bilateral posterior transverse partial cordotomy in patients with upper airway obstruction due to bilateral vocal fold paralysis. A retrospective analysis of 48 cases of upper airway obstruction due to bilateral vocal fold paralysis, who were admitted to Department of Otolaryngology Head and Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital from July 2009 to July 2019, was performed, including 13 males and 35 females. Patients' ages ranged from 27 to 83 years old. Read More

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020 Nov;55(11):1016-1021

Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Navy Medical University, Shanghai 200433, China.

To evaluate the airway and voice quality improvement in patients with bilateral vocal fold paralysis (BVFP) who underwent selective laryngeal reinnervation surgery. From January 2012 to December 2016, a retrospective study was conducted in 39 patients with BVFP who underwent selective laryngeal reinnervation surgery in Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Navy Medical University. All patients were examined by videostroboscopy, vocal function assessment, laryngeal electromyography and pulmonary function test before and after the surgery, and followed up for at least 2 years to evaluate the efficacy and safety of the surgery. Read More

Front Neurol 2020 15;11:581060. Epub 2020 Oct 15.

Clinic of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany.

To prevent severe and potentially life-threatening consequences of bilateral vocal fold paralysis (BVFP), the identification and management of reversible causes is pivotal. Myasthenia gravis (MG) presenting with BVFP is rarely reported and remains incompletely understood. Although symptom control is achievable for most MG patients with sufficient therapy, atypical clinical presentation such as BVFP might preclude diagnosis and thus effective treatment. Read More

Adv Otorhinolaryngol 2020 9;85:98-111. Epub 2020 Nov 9.

Voice and Swallowing Clinic, Otolaryngology Head & Neck Surgery Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

Injury to the recurrent laryngeal nerve (RLN) can result in impairment of all three laryngeal functions. The RLN is capable of regeneration, but laryngeal functions in cases of severe injury remain impaired. This permanent impairment is caused by either incomplete regeneration and/or occurrence of laryngeal synkinesis. Read More

Adv Otorhinolaryngol 2020 9;85:112-119. Epub 2020 Nov 9.

Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany,

Laryngeal synkinesis as a form of defective healing is the rule rather than the exception in persistent vocal fold paralysis. It typically occurs 4-6 months after the onset of the recurrent laryngeal nerve paralysis. The incidence is up to 85%. Read More

Int J Pediatr Otorhinolaryngol 2020 Nov 13;138:110254. Epub 2020 Jul 13.

Department of Pediatric Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.

Objective: Vocal fold paralysis (VFP) in adducted position remains a challenge for airway surgeons. Alternatives to tracheostomies such as lateralization, cordectomy, and posterior rib grafting disrupt the laryngeal tissue or framework and carry an increased risk of aspiration. Laryngeal reinnervation using nerve-muscle pedicle (NMP), carries the distinct advantage of preserving the larynx, sparing the recurrent laryngeal nerve, and obtaining an active VF abduction. Read More

Ear Nose Throat J 2020 Oct 22:145561320965212. Epub 2020 Oct 22.

The Graduate Institute of Clinical Medicine and Department of Otolaryngology, College of Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei.

Background: Vocal fold paralysis (VFP) can result from a variety of diseases or surgeries and has various causes. This study determined concurrent etiologies in patients who were treated in a teaching hospital (tertiary medical center).

Methods: A retrospective review of medical records of patients with VFP from September 2010 to December 2019 was performed to determine the etiology. Read More

Rev Med Suisse 2020 Oct;16(709):1845-1848

Service d'ORL et de chirurgie cervico-faciale, CHUV, 1011 Lausanne.

The surgical management of unilateral and bilateral vocal cord paralysis depends on the severity of the condition, the potential for spontaneous recovery, the patient's age and vocal expectations. Standardized re-innervation surgeries, unilateral non-selective and bilateral selective, are viable alternatives to static procedures currently under evaluation in prospective studies. Neurorraphy of the ansa cervicalis loop to the recurrent laryngeal nerve allows lasting vocal recovery and potentially superior results to medialization and thyroplasty, by maintaining the visco-elastic properties of the vocal cord and preventing its atrophy. Read More

Otolaryngol Head Neck Surg 2020 Oct 6:194599820961109. Epub 2020 Oct 6.

Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Objective: To report brain magnetic resonance imaging (MRI) and ultrasonography findings in pediatric patients with congenital idiopathic bilateral vocal fold dysfunction and analyze factors associated with its etiology and resolution.

Study Design: Case series with retrospective review.

Setting: Tertiary care multi-institutional setting: Nationwide Children's Hospital, Indiana University, University of North Carolina, and Cleveland Clinic. Read More

Int J Speech Lang Pathol 2020 Sep 16:1-10. Epub 2020 Sep 16.

Auckland District Health Board, Auckland, New Zealand.

Purpose: Dysphagia is reported following lung transplantation. Characteristics and trajectory for dysphagia are poorly understood. This retrospective study explored dysphagia and medicine regimes in patients following lung transplant. Read More

Int J Pediatr Otorhinolaryngol 2020 Nov 20;138:110325. Epub 2020 Aug 20.

Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA; Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.

Introduction: Infants with bilateral vocal fold paralysis (BVFP) can present with stridor and respiratory distress necessitating tracheostomy. The endoscopic anterior-posterior cricoid split (APCS) with balloon dilation procedure has been described as an alternative to tracheostomy in these patients. Here, we report our institution's preliminary experience with APCS and evaluate patient factors that may predispose to the success or failure of this procedure in infants with BVFP. Read More

J Voice 2020 Aug 30. Epub 2020 Aug 30.

Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan. Electronic address:

Objectives: Understanding brain activity in response to unilateral vocal fold paralysis is essential to determine the neural compensatory mechanism underlying adaptation to voice disorders and to develop novel and improved rehabilitation programs for these disorders. We aimed to clarify brain activity during phonation (prolonged vowel, |i:|) in patients with chronic left vocal fold paralysis (LVFP) and compare with that in normal controls.

Study Design: Case-control study. Read More

Endokrynol Pol 2020 ;71(4):350-358

Chair and Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland, Poland.

Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. Read More

OTO Open 2020 Jul-Sep;4(3):2473974X20946268. Epub 2020 Jul 31.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.

Endoscopic cricoid expansion and reduction are newer approaches to the management of pediatric bilateral vocal fold immobility and postlaryngotracheal reconstruction glottic insufficiency, respectively. These procedures offer a less invasive, endoscopic alternative to procedures that typically required open management with a more prolonged recovery. These technically demanding procedures are currently performed only in select centers, and there is no currently described training model for practicing them. Read More