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Rosow DE, Sulica L. Laryngoscopy of vocal fold paralysis: evaluation of consistency of
clinical findings.
Laryngoscope
. 2010; 120(7):1376-1382. EBM level 2.................44-50
Summary:
This study sent videostroboscopy examination results from patients with unilateral
vocal fold paralysis (VFP) to 22 blinded laryngologists and asked them to rate the results on
twelve different criteria. The interrater reliability for each criterion was then calculated. The
criteria with the best interrater agreement were glottic insufficiency, vocal fold bowing, and
salivary pooling, which showed moderate agreement. All other criteria showed fair or poor
agreement. The authors concluded that while it would be ideal to have a standardized rating scale
for evaluation of VFP, the lack of interrater agreement across a wide range of laryngologists with
different training and different backgrounds suggests that this may be very difficult to achieve.
Simpson CB, May LS, Green JK, et al. Vibratory asymmetry in mobile vocal folds: is it
predictive of vocal fold paresis?
Ann Otol Rhinol Laryngol
. 2011; 120(4):239-242.
EBM level 4..................................................................................................................51-54
Summary:
This study is a retrospective review of 23 patients with symptoms suggestive of glottic
insufficiency and stroboscopy examinations showing normal vocal fold mobility and vibratory
asymmetry. All patients underwent laryngeal electromyography (LEMG) to determine presence
of paresis. A total of 19 patients (83%) had evidence of paresis on LEMG. Blinded reviewers
evaluated stroboscopy examinations for presence of paresis, but their ability to predict the
distribution (sidedness) of the paresis was 37% or worse. The authors note that their findings
suggest that all clinical and stroboscopic diagnoses of vocal fold paresis should be followed up
with LEMG as the gold standard for diagnosis.
C. Office-Based Procedures
Croake DJ, Stemple JC, Uhl T, et al. Reliability of clinical office-based laryngeal
electromyography in vocally healthy adults.
Ann Otol Rhinol Laryngol
. 2014;
123(4):271-278. EBM level 3......................................................................................55-62
Summary:
Using a quantitative analysis protocol to inform an essentially qualitative technique, the
study results indicated that there was generally poor to fair reliability in the laryngeal
electromyography (LEMG) signal over testing sessions. Vocal intensity was an important variable
that affected LEMG signal reliability. Standardization of LEMG protocols using vocal control
parameters and quantitative analyses may help improve LEMG reliability in clinical settings.
Koszewski IJ, Hoffman MR, Young WG, et al. Office-based photoangiolytic laser
treatment of Reinke’s edema: safety and voice outcomes.
Otolaryngol Head Neck Surg
.
2015; 152(6):1075-1081. EBM level 4........................................................................63-69
Summary:
This study provides a retrospective analysis of patients undergoing office-based laser
treatment of endoscopically proven Reinke’s edema. Nineteen patients met criteria for the study
inclusion. Five procedures were truncated due to patient intolerance. Phonatory frequency range
increased (N = 12,
p
= 0.003), while percent jitter decreased (N = 12,
p
= 0.004). Phonation
threshold pressure decreased after treatment (N = 4,
p
= 0.049). The Voice Handicap Index also
decreased (N = 14,
p
= 0.001).