HSC Section 6 Nov2016 Green Book

Annals of Otology, Rhinology & Laryngology 125(4)

fold immobility and a minimal mucosal gap (estimated <3 mm by 2 experienced phoniatricians) in videolaryngostro- boscopy between January 2008 and January 2013. They were identified in our “Electronic Patient Record of the University Hospital Ulm”—a specially designed electronic health record. As we have a close connection to a large over-regional center of (thyroid) surgery, all their patients with voice problems are routinely seen in our department, usually the day after surgery, and could be included in this study. Taken together, all stroboscopic examinations were done 1 day to a maximum of 3 days after surgery (iatrogenic paralysis) and about up to 3 weeks after onset of the symp- toms (other paralyses). The videolaryngostroboscopic vocal fold examination was done (90° endostroboscope 5052, Wolf, Hamburg, Germany) and documented (rpSzene, Rehder, Hamburg, Germany). For measurement of the glottal gap and MW presence on the paralyzed vocal fold by a phoniatrician, phonation trials were performed with a sound pressure level of 65 dB and 100 Hz for men and 200 Hz for women. Only patients diagnosed with a UVP who had a vocal fold posi- tioned with a minimal mucosal gap (estimated <3 mm) by videolaryngostroboscopy were included in this study group. It was only in these patients that evaluation by videolaryn- gostroboscopy was technically feasible because the vocal fold could get into contact (couple). Analysis of the pres- ence of a MW in the paralyzed vocal fold was done by 2 experienced phoniatricians. Patients with chronic laryngitis/leucoplakia, carcinoma, and scar formation of the vocal folds were not included as these pathologies influence mucosal waves. Similarly, patients with a medialization or augmentation of the para- lyzed vocal fold were excluded. Positive MW (pMW) and negative MW (nMW) on the paralyzed vocal fold in stro- boscopy were associated with complete recovery of the paralysis to full adduction and abduction. All patients were followed for at least 12 months at an interval of 3 to 6 months. Statistical data analysis was performed with Microsoft Excel 2003 and SAS 9.3 (SAS Institute, Cary, North Carolina, USA). In the descriptive statistical analysis median, minimum and maximum were calculated for quan- titative variables. For qualitative variables, absolute and relative frequencies with corresponding exact 95% confi- dence interval were calculated. The study was approved by the local Ethics Committees at the University of Ulm.

median age 46.5 years; range, 16-76 years; 18 males/64 females), a malignancy-associated UVP (n = 10; median age 51.3 years; range, 16-70 years; 4 males/6 females), and an idiopathic UVP (n = 8; median age 43.5 years; range, 20.5-65.7 years; 6 males/2 females). The etiology of the 82 patients with iatrogenic/traumatic was thyroidectomy in 61 patients (56 thyroid hypertrophy and 5 patients with thyroid carcinoma), cardiac/carotid surgery in 14 patients, and spine surgery in 7 patients. In 10 patients, a UVP was observed as a primary symptom of a malignancy (8 carci- noma of the thyroid gland, 2 bronchial carcinoma), and in 8 cases, idiopathic paralysis was diagnosed. These patients received voice therapy (n = 88) or observation (n = 12). Patients with a medialization or augmentation of the para- lyzed vocal fold were not included. Time of Recovery Out of the 100 patients, a complete recovery was seen in 75 patients with none in the remaining 25 patients. This recov- ery was observed at a median of 6.6 months (range, 1-14 months) after diagnosis. In the group of the 67 patients with iatrogenic/traumatic paresis, complete recovery occurred at a median of 6.5 months (range, 2-14 months). In thyroid hypertrophy surgery associated paralysis (n = 43), recovery was observed at a median of 4.6 months (range, 2-12 months) and in surgery because of a thyroid carcinoma (n = 5) in 10.4 months (range, 4-14 months). The 1 malignancy-associated UVP recovered after 10 months and the idiopathic paralysis (n = 7) after a median of 5.7 months (range, 3-9). Relationship of Recovery With MW As mentioned before, recovery was observed in 75% (75/100; 95% CI, 65.3-83.1). In total, 80 patients had pMW and 20 nMW. In all patients with pMW at diagnosis, the chance of recovery of UVP was 91.25% (73/80; 95% CI, 82.8%- 96.4%) (Figure 1), whereas the chance of recovery of the UVP was only 10% (2/20; 95% CI, 1.2%-31.7%) in patients with nMW (Figure 2, Table 1). In the subgroup of the 82 patients with iatrogenic/trau- matic UVP, a recovery was observed in 81.7% (67/82; 95% CI, 71.6%-89.4%), especially in 90.4% (66/73; 95% CI, 81.2%-96.1%) in patients with pMW. In 3 cases with nMW that did not resolve, the nerve was cut. The best chance of recovery was in the group of the patients with idiopathic UVP in 87.5% (7/8; 95% CI, 47.4%-99.7%). All patients who recovered had pMW. Only 1 patient (10%, 1/10; 95% CI, 0.3%-44.5%) recovered in malignancy-associated UVP. This patient had nMW. Unilateral vocal fold paralyses with pMW were not observed in this group (Tables 2-4).

Results Patients, Etiology of UVP, and Therapy

A hundred patients (median age 49.6 years; range, 16-81 years; 28 males/72 females) with a UVP were included. The group was divided iatrogenic/traumatic group (n = 82;

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