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Reprinted by permission of Ann Otol Rhinol Laryngol. 2016; 125(4):331-335.

Article

Annals of Otology, Rhinology & Laryngology 2016, Vol. 125(4) 331–335 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0003489415613801 aor.sagepub.com

Prognostic Relevance of Mucosal Waves in Patients With Unilateral Vocal Fold Paralysis

Rudolf Reiter, MD, PhD 1 , Anja Pickhard, MD, PhD 2 , Sylvia Sander 3 , and Sibylle Brosch, MD, PhD 1

Abstract Objectives: To analyze the prognostic relevance of mucosal waves (MWs) for recovery of unilateral vocal fold paralysis (UVP). Methods: The charts and stroboscopic examinations of 100 consecutive patients with a complete UVP were reviewed retrospectively. All had a minimal (estimated <3 mm) mucosal gap on stroboscopy. A positive or negative MW on the paralyzed vocal fold was associated with complete recovery to full adduction and abduction. All patients were followed for at least 12 months. Results: Causes of the paralysis were iatrogenic/traumatic (n = 82), malignancy associated (n = 10), and idiopathic (n = 8). In patients with positive MW at diagnosis (n = 80), the chance of recovery of unilateral vocal fold paralysis was 91.25%, whereas the chance of recovery with a negative mucosal wave (n = 20) was only 10%. Conclusion: Positive MWs in stroboscopy are a predictor for recovery of (iatrogenic/traumatic) unilateral vocal fold paralysis and should be used in routine diagnostic assessment.

Keywords unilateral vocal fold paralysis, mucosal wave, microstroboscopy, recovery

Introduction Unilateral vocal fold paralysis (UVP) is a challenge for oto- laryngologists and phoniatricians. Insufficient glottic clo- sure during phonation can lead to severe vocal impairment with dysphonia and reduced vocal intensity. The etiology of UVP is often traumatic (especially in thyroid surgery) fol- lowed by malignancy-associated and idiopathic paralysis. 1 Recovery of vocal fold paralysis is mainly observed within 12 months after onset, as shown in a literature review of 717 cases with an idiopathic UVP. 2,3 Recovery of postoperative vocal fold paralysis in patients with thyroidectomy usually occurs within the first 6 months, 4 but according to a litera- ture review, up to 11% do not recover. 5 Knowing the progno- sis of UVP is helpful in planning therapy such as voice therapy and augmentation, either early temporary or perma- nent. 6-8 Stroboscopy is a tool for imaging the vibration of the vocal folds during phonation, especially the mucosal waves. 9,10 By analyzing the vibrations of the vocal folds, an assessment can be made as to the state of the mucosa (cover) and the underlying laryngeal muscle tone (body). 9,11 In patients with UVP, reduced vocal fold movement (adduction or abduction), vocal fold bowing, incomplete glottis closure,

or a vibratory asymmetry, and absent mucosal waves (MW) can be observed in videostroboscopy. Recurrence of MW suggests reinnervation of the paretic vocal fold. 12-15 The aim of this study was to analyze the prognostic relevance of MW for recovery of mobility to full adduction and abduction in unilateral vocal fold paralysis in 100 patients. Material and Methods A retrospective review was made of a select group of 100 consecutive patients who had a UVP with complete vocal 1 Section of Phoniatrics and Pedaudiology, Department of Otolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany 2 Department of Otolaryngology Head and Neck Surgery, Technical University, Munich, Germany 3 Institute of Epidemiology and Medical Biometry, University of Ulm, Germany Corresponding Author: Rudolf Reiter, Section of Phoniatrics and Pedaudiology, Department of Otolaryngology, Head and Neck Surgery, University of Ulm,

Frauensteige 12, 89070 Ulm, Germany. Email: rudolf.reiter@uniklinik-ulm.de

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