HSC Section 6 Nov2016 Green Book

agreement) to 0.55 (moderate agreement). Ratings for arytenoid stability, arytenoid position, and height mis- match generated the poorest values, whereas glottic insufficiency, vocal fold bowing, and salivary pooling resulted in the best (Fig. 3–Fig. 8]. DISCUSSION Traditionally conceptualized as an all-or-none phe- nomenon, VFP has been shown by ample clinical and laboratory investigation to represent a continuum of neurogenic dysfunction encompassing partial denerva- tion, complete denervation, and variable degrees and patterns of reinnervation. It should come as no surprise, then, that its clinical appearance too is highly variable. This is not synonymous with random, however; this vari- ability no doubt reflects the considerable heterogeneity Fig. 5. Vocal fold tone decreased. This case generated the most consistent rating for decreased vocal fold tone. All ratings were made from dynamic examinations. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]

in the neurologic dysfunction that underlies the immo- bile vocal fold. Historical efforts to decipher the laryngoscopic appearance have fallen short, compro- mised by oversimplifications and an incomplete understanding of the relevant pathophysiology. Given these limitations, we find these failures neither particu- larly surprising nor discouraging. Lest a re-examination of laryngoscopy in VFP be considered unnecessary or irrelevant, it is important to appreciate that existing neurodiagnostic techniques have also been defeated by the complex neurologic picture underlying the paralyzed vocal fold. Electromyography has proved to be as qualitative as laryngoscopy, and it is similarly susceptible to individual variation in interpre- tation. Although it has yielded crucial insight in the Fig. 7. Glottic insufficiency: none to mild. This case generated the most consistent rating for no or mild glottic insufficiency. All rat- ings were made from dynamic examinations. [Color figure can be viewed in the online issue, which is available at www.interscience. wiley.com.]

Fig. 8. Glottic insufficiency: moderate to severe. This case gener- ated the most consistent rating for moderate to severe glottic insufficiency. All ratings were made from dynamic examinations. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]

Fig. 6. Vocal fold shortened. This case generated the most con- sistent rating for shortened vocal fold. All ratings were made from dynamic examinations. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]

Laryngoscope 120: July 2010

Rosow and Sulica: Laryngoscopy of Vocal Fold Paralysis

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