246 / 412
Carotid endarterectomy
. Stroke and death rates in caro-
tid endarterectomy have been shown to be higher for
left-sided vs right-sided surgeries. Explanations for
this observation include that due to the dominance of
the left cerebral hemisphere, left-sided events are
more symptomatic than right-sided events, and there-
fore more surgeries occur on the left side. There also
may be a role in surgeon handedness, making left-
sided carotid endarterectomies more technically diffi-
cult for right-handed surgeons.
25
Intubation
. More people in general are right-handed;
there may be some greater tendency for right-
handed anesthetists to traumatize the left hemilarynx
more than the right during intubation. The mechan-
ism of UVFP with intubation is not known but may
relate to an acute event (at the time of intubation) or
a longer-term event (while the tube is in place) that
may be related to the cuff pressure or tube position-
ing. Some postintubation vocal fold immobility may
Table 3.
Presentation Time for 92 Patients Referred to the WUSM.
a
Etiology
n
Fraction of
Original Total (%)
Outside ENT
Presentation, Median, mo
WUSM ENT
Presentation, Median, mo Difference
Range in
Difference
Carotid surgery
4
4/22 (18.2)
1.8
8.5
6.7
2-178
Cervical spine surgery
5
5/48 (10.4)
3.0
7.0
4.0
0.5-43
Lateral neck surgery
5
5/61 (8.2)
4.0
15.0
11.0
2-116
Parathyroid surgery
3
3/18 (16.7)
3.0
8.0
5.0
5-49
Thyroid surgery
17
17/140 (12.1)
1.5
12.0
10.5
0.5-111
Lung surgery
5
5/73 (6.8)
2.0
92.0
90.0
1-104
Cardiac surgery
4
4/58 (6.9)
2.5
6.5
4.0
2-5
Laryngeal cancer
4
4/20 (20.0)
1.5
4.5
3.0
3-7
Thyroid cancer
4
4/14 (28.6)
2.1
6.0
3.9
1.75-19
Idiopathic
21
21/124 (16.9)
3.0
12.0
9.0
0.5-51
Intubation
4
4/58 (6.9)
2.0
3.8
1.8
1-3
CVA
4
4/18 (22.2)
2.5
14.0
11.5
3-150
Total
b
92
92/938 (9.8)
2.1
9.5
7.4
0.5-563
Abbreviations: ENT, ear, nose, and throat; WUSM, Washington University School of Medicine.
a
Excludes etiologies with less than 3 patients.
b
Includes 12 outside referral patients not listed above.
Figure 2.
Histogram and cumulative plot of time from unilateral
vocal fold paralysis symptom onset to presentation to the
Washington University School of Medicine (WUSM; open bars) or
to outside otolaryngologist prior to referral to the WUSM (solid
bars; 9.8% of cases). Data shown for first 3 years following onset.
Figure 3.
Histogram and cumulative plot from
Figure 2
, focusing
on the first 4 months after symptom onset. WUSM, Washington
University School of Medicine.
Otolaryngology–Head and Neck Surgery 151(2)
21