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Annals of Otology, Rhinology & Laryngology

2016, Vol. 125(4) 331–335

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DOI: 10.1177/0003489415613801

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Article

Introduction

Unilateral vocal fold paralysis (UVP) is a challenge for oto-

laryngologists and phoniatricians. Insufficient glottic clo-

sure during phonation can lead to severe vocal impairment

with dysphonia and reduced vocal intensity. The etiology of

UVP is often traumatic (especially in thyroid surgery) fol-

lowed by malignancy-associated and idiopathic paralysis.

Recovery of vocal fold paralysis is mainly observed within

12 months after onset, as shown in a literature review of 717

cases with an idiopathic UVP.

2,3

Recovery of postoperative

vocal fold paralysis in patients with thyroidectomy usually

occurs within the first 6 months,

but according to a litera-

ture review, up to 11% do not recover.

Knowing the progno-

sis of UVP is helpful in planning therapy such as voice

therapy and augmentation, either early temporary or perma-

nent.

6-8

Stroboscopy is a tool for imaging the vibration of the

vocal folds during phonation, especially the mucosal

waves.

9,10

By analyzing the vibrations of the vocal folds, an

assessment can be made as to the state of the mucosa (cover)

and the underlying laryngeal muscle tone (body).

9,11

patients with UVP, reduced vocal fold movement (adduction

or abduction), vocal fold bowing, incomplete glottis closure,

or a vibratory asymmetry, and absent mucosal waves (MW)

can be observed in videostroboscopy. Recurrence of MW

suggests reinnervation of the paretic vocal fold.

12-15

The aim

of this study was to analyze the prognostic relevance of MW

for recovery of mobility to full adduction and abduction in

unilateral vocal fold paralysis in 100 patients.

Material and Methods

A retrospective review was made of a select group of 100

consecutive patients who had a UVP with complete vocal

Section of Phoniatrics and Pedaudiology, Department of

Otolaryngology, Head and Neck Surgery, University of Ulm, Ulm,

Germany

Department of Otolaryngology Head and Neck Surgery, Technical

University, Munich, Germany

Institute of Epidemiology and Medical Biometry, University of Ulm,

Germany

Corresponding Author:

Rudolf Reiter, Section of Phoniatrics and Pedaudiology, Department

of Otolaryngology, Head and Neck Surgery, University of Ulm,

Frauensteige 12, 89070 Ulm, Germany.

Email:

rudolf.reiter@uniklinik-ulm.de

Prognostic Relevance of Mucosal

Waves in Patients With Unilateral

Vocal Fold Paralysis

Rudolf Reiter, MD, PhD

, Anja Pickhard, MD, PhD

, Sylvia Sander

and Sibylle Brosch, MD, PhD

Abstract

Objectives:

To analyze the prognostic relevance of mucosal waves (MWs) for recovery of unilateral vocal fold paralysis

(UVP).

Methods:

The charts and stroboscopic examinations of 100 consecutive patients with a complete UVP were reviewed

retrospectively. All had a minimal (estimated <3 mm) mucosal gap on stroboscopy. A positive or negative MW on the

paralyzed vocal fold was associated with complete recovery to full adduction and abduction. All patients were followed

for at least 12 months.

Results:

Causes of the paralysis were iatrogenic/traumatic (n = 82), malignancy associated (n = 10), and idiopathic

(n = 8). In patients with positive MW at diagnosis (n = 80), the chance of recovery of unilateral vocal fold paralysis was

91.25%, whereas the chance of recovery with a negative mucosal wave (n = 20) was only 10%.

Conclusion:

Positive MWs in stroboscopy are a predictor for recovery of (iatrogenic/traumatic) unilateral vocal fold

paralysis and should be used in routine diagnostic assessment.

Keywords

unilateral vocal fold paralysis, mucosal wave, microstroboscopy, recovery

Reprinted by permission of Ann Otol Rhinol Laryngol. 2016; 125(4):331-335.