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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.
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;
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).
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