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Fulltext Congenital bilateral vocal cord paralysis

Hasniah AL, Asiah K, Mariana D, Anida AR, Norzila MZ, Sahrir S

Med J Malaysia, 2006 Dec;61(5):626-9.
PMID: 17623966 MyJurnal

Congenital upper airway obstruction is a relatively rare but important cause of major respiratory problems in the neonatal period. Vocal cord paralysis is the second most common cause of congenital airway obstruction presenting with neonatal stridor. It is often the reason for the failure of neonates to wean from the respiratory support. A retrospective analysis of medical record review was conducted. There were seven paediatric patients diagnosed with bilateral vocal fold paralysis in the past three years, of which five were recently diagnosed. All patients underwent flexible with/without rigid bronchoscopes to confirm the diagnosis. This case series highlight our experience in managing the problem of bilateral vocal cord paralysis in the paediatric population, with particular emphasis on their clinical presentations, associated complications and both upper and lower airway abnormalities. The management options and outcome of these patients will also be discussed.

Matched MeSH terms: Vocal Cord Paralysis/diagnosis*
Fulltext A case of Hodgkin's disease presenting with recurrent laryngeal nerve palsy and tracheoesophageal fistula

Munshi A, Pandey MB, Kumar L, Karak AK, Mohanti BK

Med J Malaysia, 2006 Mar;61(1):97-9.
PMID: 16708743

Malignancy is the most common cause of tracheoesophageal fistulas. The malignancies commonly implicated in the development of tracheoesophageal fistulas are primary bronchial or esophageal carcinomas. Hodgkins disease rarely leads to such a fistula. We report a case of Hodgkin's disease with a tracheoesophageal fistula as well as a left recurrent nerve palsy at presentation. This presentation has no precedent in literature. The patient was treated with systemic chemotherapy and involved field radiotherapy. On follow up 1 year after the completion of treatment, he was clinically and radiologically disease free.

Matched MeSH terms: Vocal Cord Paralysis/diagnosis*
Quantitative laryngeal electromyography (LEMG) in unilateral vocal fold paralysis: Developing normative values using the opposite normal mobile vocal fold

Chen IHK, Remli R, Azman M, Ubaidah MA, Mohamed AS, Baki MM

Auris Nasus Larynx, 2021 Dec;48(6):1140-1149.
PMID: 33896673 DOI: 10.1016/j.anl.2021.03.028

OBJECTIVE: Laryngeal electromyography (LEMG) is used to confirm neuropathy; traditionally, it is evaluated qualitatively. This study aimed to develop normative values for the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex by determining the mean turns (MT) and mean amplitudes (MA) using the opposite normal mobile vocal fold in unilateral vocal fold paralysis (VFP). This study also compared the MT and MA of the paralyzed vocal fold with that of the normal side and analyzed their correlations.
METHODS: This is a cross-sectional study in which 77 patients (18 males, 59 females, mean age of 48) with unilateral VFP with an opposite normal mobile vocal fold underwent LEMG with a standardized protocol. Koufman gradings and MT and MA were used for the qualitative and quantitative evaluations. Mann-Whitney U test was performed to compare the median of the turns and amplitudes between the opposite normal mobile vocal fold and the paralyzed side. A linear-scale graphical "cloud" of the normal TA-LCA muscle complex was generated using logarithmic regression analysis. The qualitative and quantitative parameters were analyzed using multiple analysis of variance and Kruskall-Wallis test. Post-hoc analysis was performed to further determine the differences of the significance between both parameters. The correlation between the qualitative and quantitative parameters was analyzed using Spearman correlation.
RESULTS: The MT and MA were significantly higher for the normal TA-LCA muscle complex than the paralyzed side (582 vs. 336; 412 vs. 296, respectively) and the median of the turns and amplitudes were significantly lower in the paralyzed side with p-values <0.001. A significant difference was observed between the Koufman grading and the combination of MT and MA [F (8,144) = 73.254] and between the Koufman grading and MT and MA individually [H (4, 72) = 18.3 and H (4, 72) =33.4], in which both had p-values <0.001. A moderate negative linear relationship was seen between the Koufman grading and MT and MA. On further analysis, it was revealed that only certain pairs of Koufman grading were statistical significant.
CONCLUSIONS: This study was the first to present the quantitative normative values and "cloud" of the TA-LCA muscle complex using the opposite normal mobile vocal fold in patients with unilateral VFP in which it is comparable to healthy controls. We concluded that quantitative LEMG supports the qualitative Koufman grading method however it cannot be used independently to determine the severity of neuropathy.

Matched MeSH terms: Vocal Cord Paralysis/diagnosis
Maximum vocal intensity as a primary outcome measure in unilateral vocal fold paralysis patients

Johari SF, Azman M, Mohamed AS, Baki MM

J Laryngol Otol, 2020 Dec;134(12):1085-1093.
PMID: 33308327 DOI: 10.1017/S0022215120002558

OBJECTIVE: To evaluate voice intensity as the primary outcome measurement when treating unilateral vocal fold paralysis patients.
METHODS: This prospective observational study comprised 34 newly diagnosed unilateral vocal fold paralysis patients undergoing surgical interventions: injection laryngoplasty or medialisation thyroplasty. Voice assessments, including maximum vocal intensity and other acoustic parameters, were performed at baseline and at one and three months post-intervention. Maximum vocal intensity was also repeated within two weeks before any surgical interventions were performed. The results were compared between different time points and between the two intervention groups.
RESULTS: Maximum vocal intensity showed high internal consistency. Statistically significant improvements were seen in maximum vocal intensity, Voice Handicap Index-10 and other acoustic analyses at one and three months post-intervention. A significant moderate negative correlation was demonstrated between maximum vocal intensity and Voice Handicap Index-10, shimmer and jitter. There were no significant differences in voice outcomes between injection laryngoplasty and medialisation thyroplasty patients at any time point.
CONCLUSION: Maximum vocal intensity can be applied as a treatment outcome measure in unilateral vocal fold paralysis patients; it can demonstrate the effectiveness of treatment and moderately correlates with self-reported outcome measures.

Matched MeSH terms: Vocal Cord Paralysis/diagnosis