HSC Section 6 Nov2016 Green Book

Spataro EA, Grindler DJ, Paniello RC. Etiology and time to presentation of unilateral vocal fold paralysis. Otolaryngol Head Neck Surg . 2014; 151(2):286-293. EBM level 4...........................................................................................................................17-24 Summary: Records were reviewed for 10 years at a single institution for unilateral vocal fold paralysis (UVFP); 938 patients met inclusion criteria. Of this group, 522 patients (55.6%) had UVFP due to surgery; 158 patients (16.8%) had UVFP associated with thyroid/parathyroid surgery, while in 364 patients (38.8%), UVFP was due to non-thyroid surgery. Of the total group, 416 patients (44.4%) had nonsurgical etiologies, 124 patients (13.2%) had idiopathic UVFP, and 621 patients (66.2%) had left-sided UVFP. Thyroidectomy remains the leading cause of surgery- related UVFP. Patients typically are seen within 3 to 4 months of onset. Summary: Wu and Sulica surveyed expert laryngologists who diagnosed vocal fold paresis predominantly on stroboscopic examination. Gross motion abnormalities had the highest positive predictive value. Laryngeal electromyography was infrequently used to assess for vocal fold paresis. B. Stroboscopy Djukic V, Milovanovic J, Jotic AD, Vukasinovic M. Stroboscopy in detection of laryngeal dysplasia: effectiveness and limitations. J Voice . 2014; 28(2):262.e13- 262.e21. EBM level 3a................................................................................................30-38 Summary: This is a large study examining pre- and posttreatment stroboscopic findings in a prospectively collected group of 112 patients with dysplasia. There were fairly stringent exclusion criteria. The main finding was that abnormal amplitude of vocal fold vibration was significantly associated with recurrence. The type of cordectomy performed for the dysplasia and involvement of the vibratory segment was also associated with recurrence of dysplasia. Most recurrence occurred in a moderate dysplasia group. One limitation was that there were smaller numbers of patients in each dysplasia category; however, the study did highlight that caution should be exercised in the posttreatment follow-up period, and that stroboscopy has to be used in combination with other methods for an accurate diagnosis but can be helpful in predicting recurrence. Reiter R, Pickhard A, Sander S, Brosch S. Prognostic relevance of mucosal waves in patients with unilateral vocal fold paralysis. Ann Otol Rhinol Laryngol . 2016; 125(4):331-335. EBM level 4......................................................................................39-43 Summary: This is a retrospective review of 100 patients with unilateral vocal fold paralysis looking at stroboscopic characteristics and relationship to eventual outcome. The majority of patients (75%) recovered function, and in all patients who recovered, there was an existing mucosal wave. In patients who did not recover function, only 10% had a mucosal wave. Wu AP, Sulica L. Diagnosis of vocal fold paresis: current opinion and practice. Laryngoscope . 2015; 125(4):904-908. EBM level 5..................................................25-29