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This questionnaire was distributed to attendees at three
national laryngology conferences that took place in 2013: 1) the
Neurolaryngology Study Group at the American Academy of
Otolaryngology Annual Meeting, Vancouver, BC; 2) the Fall
Voice Conference, Atlanta, GA; and 3) Advances and Controver-
sies in Laryngology, Elk Grove, IL. Duplicate responses were
avoided, and confidentiality was preserved by separately track-
ing responder identity. Responses were collated anonymously
and subjected to cross-tabulated data analysis. Only otolaryng-
ologists were surveyed.
Physicians whose practices did not predominantly focus on
laryngology (
<
75% laryngology), who did not see patients with
dysphonia as a chief complaint, or who never diagnosed
patients with VFP were excluded. Responders still in training,
whether in residency or fellowship, were also excluded. Incom-
plete surveys were removed from analysis. One response with
internally conflicting responses (a greater number of monthly
paresis diagnoses than new dysphonic patients) was excluded.
Statistical analysis using descriptive frequencies and cross-
tabulations were performed with 2011 Microsoft Excel.
RESULTS
A total of 88 responses were received. After apply-
ing the exclusion criteria, a total of 58 entries were
included for data analysis. Respondent demographics
are summarized in Table I. The vast majority of
respondents are laryngology fellowship-trained otolar-
yngologists with predominantly adult practices in the
United States. Practice specifics related to VFP are sum-
marized in Table II. Most respondents (72%) base diag-
nosis principally on stroboscopy. Only 12 (21%)
respondents performed LEMG on greater than 50% of
their VFP patients. Figure 4 and Table III summarize
the respondents’ opinion regarding positive predictive
value of laryngoscopic findings in VFP patients. In gen-
eral, abnormalities of gross vocal fold motion were con-
sidered to be most highly predictive, followed by
stroboscopic signs. Associated lesions, namely contact
lesions and pseudocysts, were not considered highly
diagnostic of paresis. Respondents rated the sensitivity
of LEMG at 61
6
3.7%,
r
5
28.
DISCUSSION
The prevalence and clinical importance of VFP is
not yet established, which should not be surprising
when diagnostic criteria remain under discussion, but it
has the potential to be substantial. Among our respond-
ents, VFP was diagnosed 8 times in a typical month, or
roughly 100 times per year, and was found in about one-
sixth of new patients presenting with voice complaints.
By comparison, the largest reported series of VFP only
consist of under 50 patients per year reviewed.
2,3,5
The
prevalence of paresis has been proposed to be similar to
paralysis on the basis of similar pathophysiology.
1
The
prevalence of paralysis varies widely from report to
report and is dependent on practice environment, geo-
graphic location, patient selection, and a host of other
factors. Studies from one center have reported 46% prev-
alence of mild vocal hypomobility among patients with
vocal complaints, 15% to 23% among singing teachers
without vocal complaints, and 71% among singing teach-
ers with technical difficulty complaints.
12–14
Simpson
et al.
5
drew cases from a series of 739 patients present-
ing to their tertiary laryngology practice over a 4-year
period with a chief complaint of dysphonia. Of 195
(26.4%) patients initially diagnosed with VFP or paraly-
sis by videostroboscopy, only 13 or 1.8% of the overall
dysphonic patients had LEMG-confirmed unilateral or
bilateral VFP. Koufman et al.
15
reviewed 415 patients
who underwent LEMG over a 5-year period. This group
found “abnormal diagnostic LEMG” results (presumed to
Fig. 2. A 38-year-old woman with atrophy of the left vocal
fold, incomplete glottic closure, unilateral (right) supraglottic
hyperfunction, and impairment of arytenoid rotation on the left.
Fig. 3. A 30-year-old woman with a left-sided contact lesion and
decreased left vocal fold adduction.
TABLE I.
Respondent Demographics (N
5
58).
Years in practice posttraining 11
6
1.1 (
r
5
8.6, range 0.1–31)
Laryngology fellowship trained
54 (93%)
Practicing in the United States
56 (97%)
Percent of practice which is
laryngology
93
6
1.0%
Percent adult patients
91
6
1.1%
Fig. 1. A 44-year-old man with atrophy of the left hemilarynx, man-
ifested as an enlarged laryngeal ventricle, and the beginning of a
right vocal fold pseudocyst.
Laryngoscope 125: April 2015
Wu and Sulica: Paresis Survey
26