Vocal Fold Paralysis Flashcards
What study should you order to evaluate a patient with idiopathic unilateral vocal fold paralysis?
CT with contrast of the neck, along the entire course of the RLN (from the skull base through the aortic arch)
Typical presentation of unilateral vocal fold paralysis?
- hoarseness
- dysphagia
- dyspnea with speaking (but not with exercise)
Typical presentation of bilateral vocal fold paralysis?
- dyspnea with exertion
- inspiratory stridor
*May be life-threatening and present as an airway emergency
After what time frame would you be doubtful vocal fold paresis will recover?
Rarely does this improve after 6 months
Treatment goal of unilateral vocal fold paralysis?
Medialize the immobile vocal fold to allow the mobile cord to meet it and restore glottic competence
Treatment goal of bilateral vocal fold paralysis?
-Enlarge the airway (often at the expense of the voice) by lateralizing on of the paralyzed folds
True or false: the position of the affected true vocal fold correlates with the level or extent of injury to the vagus or RLN branch
False
Laryngeal EMG: what does denervated muscle show?
- fibrillation potentials
- positive waves
Laryngeal EMG: what does reinnervated muscle show?
-polyphasic motor units
True or false: Augmenting a unilateral true vocal fold (TVF) immobility eliminates the risk of aspiration when there is also a sensory deficit from an affected SLN (superior laryngeal nerve)?
False
Vocal cord hypomobility
new onset of partial TVF motion abnormality
Vocal cord paresis
Partial TVF motion abnormality >6 months
Vocal cord immobility
TVF is not moving, but not determined if mechanical or neurological cause
Vocal cord paralysis
Lack of movement from the TVF from a permanent neurologic cause
