HSC Section 6 Nov2016 Green Book

Annals of Otology, Rhinology & Laryngology 125(4)

Table 2.  Recovery of Unilateral Vocal Fold Paralysis (UVP) Dependent on Mucosal Wave (MW) in Iatrogenic/Traumatic UVP. UVP Positive MW Negative MW Total Recovery 66 (42 thyroid hypertrophy, 5 thyroid carcinoma, 12 cardiac/carotid surgery, 7 spine surgery) 1 (1 thyroid hypertrophy) 67 No recovery 7 (6 struma, 1 cardiac/carotds surgery) 8 (7 thyroid hypertrophy, 1 cardiac/carotid surgery) 15 Total 73 9 82

Table 3.  Recovery of Unilateral Vocal Fold Paralysis (UVP) Dependent on Mucosal Wave (MW) in Malignancy-Associated UVP.

(iatrogenic/traumatic) UVP and should be used in routinely for diagnosis and prognosis

Acknowledgment We thank John Bennett, FRCS, for critically reading this manuscript. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. References 1. Reiter R, Pickhard A, Smith E, et al. Vocal cord paralysis— analysis of a cohort of 400 patients. Laryngorhinootologie . 2015;94(2):91-96. 2. Sulica L. The natural history of idiopathic unilateral vocal fold paralysis: evidence and problems. Laryngoscope . 2008;118(7):13030-13037. 3. Misono S, Merati AL. Evidence-based practice: evalua- tion and management of unilateral vocal fold paralysis. Otolaryngol Clin North Am . 2012;45(5):1083-1108. 4. Steurer M, Passler C, Denk DM, Schneider B, Niederle B, Bigenzahn W. Advantages of recurrent laryngeal nerve iden- tification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative e laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope . 2002;112(1):124-133. 5. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A; German IONM Study Group. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg . 2008;32(7):1358-1366. 6. Reiter R, Brosch S. Laryngoplasty with hyaluronic acid in patients with unilateral vocal fold paralysis. J Voice . 2013;26:785-791. 7. Friedman AD, Burns JA, Heaton JT, Zeitels SM. Early versus late injection medialization for unilateral vocal cord paralysis. Laryngoscope . 2010;120(10):2042-2046. 8. Yung KC, Likhterov I, Courey MS. Effect of temporary vocal fold injection medialization on the rate of permanent medialization laryngoplasty in unilateral vocal fold paralysis patients. Laryngoscope . 2011;121(10):2191-2194.

Positive MW Negative MW Total

UVP

Recovery

0 0

1 (1 thyroid carcinoma) 9 (7 thyroid carcinoma, 2 bronchial carcinoma)

 1  9

No recovery

Total

0

10

10

recovery of a (iatrogenic/traumatic) UVP. It was shown that the chance of recovery of UVP was over 90% when pMW were present at diagnosis in patients with a UVP, whereas only in 10% if not. Laryngostroboscopy is always done rou- tinely in patients with UVP by an experienced phoniatrician or laryngologist. It is a noninvasive procedure that takes only a few minutes. A disadvantage of laryngostrobsocopy is the fact that in our experience, reliable stroboscopic signals are only obtained in patients with the paralyzed vocal fold close to midline during phonation (glottis gap ≤ 3 mm during pho- nation). This is the reason why only 61 out of 100 patients could be analysed in a study by Harries and Morrison. 9 In a recent study with 400 patients with a vocal fold paralysis, it was shown that microstroboscopy was technically feasi- ble in 76% of the patients because the vocal folds could get into contact (couple). 1 These data show that a routinely performed microlarygostroboscopy is a very good, nonin- vasive alternative to EMG in patents with UVP and—in addition—much better tolerated and less expensive. Conclusion The authors conclude that positive mucosal waves in microstroboscopy are a simple predictor for recovery of Table 4.  Recovery of Unilateral Vocal Fold Paralysis (UVP) Dependent on Mucosal Wave (MW) in Idiopathic UVP. UVP Positive MW Negative MW Total Recovery 7 0 7 No recovery 0 1 1 Total 7 1 8

42