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European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 10, pp 2535–2540 | Cite as

Vocal fold paresis: Medical specialists’ opinions on standard diagnostics and laryngeal findings

  • Gerd Fabian Volk
  • Sebastian Themel
  • Markus Gugatschka
  • Claus Pototschnig
  • Christian Sittel
  • Andreas H. Müller
  • Orlando Guntinas-Lichius
  • For the Working Group on Laryngology and Tracheal Diseases of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the Working Group on Neurolaryngology of the European Laryngological Society (ELS)
Laryngology

Abstract

Purpose

There is still no clear consensus on the diagnostic value of specific laryngeal findings in patients with suspected vocal fold paresis (VFP). The aim of the study was to establish expert opinion on criteria for the diagnosis of VFP in Europe.

Methods

A cross-sectional survey using the questionnaire introduced by Wu and Sulica for US American experts was addressed to laryngeal experts in Germany, Austria, and Switzerland and in a second survey wave to members of the European Laryngological Society.

Results

100 respondents returned survey 1 (response rate 47.2%). 26% worked at a university department. 28% regularly used laryngeal electromyography (LEMG). A pathologic test results in LEMG was considered to have the strongest positive predictive value for VFP (79 ± 23%), followed by a decreased vocal fold abduction (70 ± 29%), decreased vocal fold adduction (61 ± 34%), and atrophy of the hemilarynx (61 ± 31%). The multivariate analysis showed the predictive value of LEMG was estimated lower by respondents from non-university hospital (β = − 16.33; confidence interval (CI) = − 25.63 to − 7.02; p = 0.001) and higher in hospitals with higher frequency of VFP patients per months (β = 1.57; CI = − 0.98 to 2.16; p < 0.0001). 30 ELS members returned survey 2 (response rate, 8.4%). Their answers were not significantly different to survey 1.

Conclusions

The laryngology experts in Europe rely on LEMG for diagnosis of VFP like the US American experts, but paradoxically only a minority uses LEMG frequently. Next to LEMG, motion abnormities were considered to have the best predictive value for the diagnosis of VFP.

Keywords

Neurolaryngology Vocal fold paresis Vocal fold motion Vocal fold immobility Vocal fold paralysis Laryngoscopy Laryngostroboscopy Laryngeal electromyography Survey 

Notes

Compliance with ethical standards

Conflict of interest

All authors have indicated that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The survey and its data analysis were approved by the local Ethical Committee (Ethical Committee, Jena University Hospital, Germany, No. 2018-1071-Bef).

Supplementary material

405_2018_5102_MOESM1_ESM.docx (51 kb)
Supplementary material 1 (DOCX 50 KB)

References

  1. 1.
    Syamal MN, Benninger MS (2016) Vocal fold paresis: a review of clinical presentation, differential diagnosis, and prognostic indicators. Curr Opin Otolaryngol Head Neck Surg 24(3):197–202.  https://doi.org/10.1097/MOO.0000000000000259 CrossRefPubMedGoogle Scholar
  2. 2.
    Wu AP, Sulica L (2015) Diagnosis of vocal fold paresis: current opinion and practice. Laryngoscope 125(4):904–908.  https://doi.org/10.1002/lary.25004 CrossRefPubMedGoogle Scholar
  3. 3.
    Madden LL, Rosen CA (2017) Evaluation of vocal fold motion abnormalities: are we all seeing the same thing? J Voice 31(1):72–77.  https://doi.org/10.1016/j.jvoice.2015.12.009 CrossRefPubMedGoogle Scholar
  4. 4.
    Guillemin F, Bombardier C, Beaton D (1993) Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46(12):1417–1432CrossRefPubMedGoogle Scholar
  5. 5.
    Grosheva M, Wittekindt C, Pototschnig C, Lindenthaler W, Guntinas-Lichius O (2008) Evaluation of peripheral vocal cord paralysis by electromyography. Laryngoscope 118(6):987–990.  https://doi.org/10.1097/MLG.0b013e3181671b2d CrossRefPubMedGoogle Scholar
  6. 6.
    Smith LJ, Rosen CA, Munin MC (2016) Vocal fold motion outcome based on excellent prognosis with laryngeal electromyography. Laryngoscope 126(10):2310–2314.  https://doi.org/10.1002/lary.25910 CrossRefPubMedGoogle Scholar
  7. 7.
    Pardo-Maza A, Garcia-Lopez I, Santiago-Perez S, Gavilan J (2017) Laryngeal electromyography for prognosis of vocal fold paralysis. J Voice 31(1):90–93.  https://doi.org/10.1016/j.jvoice.2016.02.018 CrossRefPubMedGoogle Scholar
  8. 8.
    Volk GF, Hagen R, Pototschnig C, Friedrich G, Nawka T, Arens C, Mueller A, Foerster G, Finkensieper M, Lang-Roth R, Sittel C, Storck C, Grosheva M, Kotby MN, Klingner CM, Guntinas-Lichius O (2012) Laryngeal electromyography: a proposal for guidelines of the European Laryngological Society. Eur Arch Otorhinolaryngol 269(10):2227–2245.  https://doi.org/10.1007/s00405-012-2036-1 CrossRefPubMedGoogle Scholar
  9. 9.
    Blitzer A, Crumley RL, Dailey SH, Ford CN, Floeter MK, Hillel AD, Hoffmann HT, Ludlow CL, Merati A, Munin MC, Robinson LR, Rosen C, Saxon KG, Sulica L, Thibeault SL, Titze I, Woo P, Woodson GE (2009) Recommendations of the Neurolaryngology Study Group on laryngeal electromyography. Otolaryngol Head Neck Surg 140(6):782–793.  https://doi.org/10.1016/j.otohns.2009.01.026 CrossRefPubMedGoogle Scholar
  10. 10.
    Munin MC, Heman-Ackah YD, Rosen CA, Sulica L, Maronian N, Mandel S, Carey BT, Craig E, Gronseth G (2016) Consensus statement: using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis. Muscle Nerve 53(6):850–855.  https://doi.org/10.1002/mus.25090 CrossRefPubMedGoogle Scholar
  11. 11.
    Volk GF, Pototschnig C, Mueller A, Foerster G, Koegl S, Schneider-Stickler B, Rovo L, Nawka T, Guntinas-Lichius O (2015) Teaching laryngeal electromyography. Eur Arch Otorhinolaryngol 272(7):1713–1718.  https://doi.org/10.1007/s00405-015-3568-y CrossRefPubMedGoogle Scholar
  12. 12.
    Crespo AN, Kimaid PA, Machado Junior AJ, Wolf AE (2015) Laryngeal electromyography: are the results reproducible? J Voice 29(4):498–500.  https://doi.org/10.1016/j.jvoice.2014.09.009 CrossRefPubMedGoogle Scholar
  13. 13.
    Kimaid PA, Crespo AN, Moreira AL, Wolf AE, Franca MC Jr (2015) Laryngeal electromyography techniques and clinical use. J Clin Neurophysiol 32(4):274–283.  https://doi.org/10.1097/WNP.0000000000000185 CrossRefPubMedGoogle Scholar
  14. 14.
    Woo P, Parasher AK, Isseroff T, Richards A, Sivak M (2016) Analysis of laryngoscopic features in patients with unilateral vocal fold paresis. Laryngoscope 126(8):1831–1836.  https://doi.org/10.1002/lary.25790 CrossRefPubMedGoogle Scholar
  15. 15.
    Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, Deckard NA, Dawson C, Driscoll C, Gillespie MB, Gurgel RK, Halperin J, Khalid AN, Kumar KA, Micco A, Munsell D, Rosenbaum S, Vaughan W (2013) Clinical practice guideline: Bell’s palsy. Otolaryngol Head Neck Surg 149(3 Suppl):S1–S27.  https://doi.org/10.1177/0194599813505967 CrossRefPubMedGoogle Scholar
  16. 16.
    Isseroff TF, Parasher AK, Richards A, Sivak M, Woo P (2016) Interrater reliability in analysis of laryngoscopic features for unilateral vocal fold paresis. J Voice 30(6):736–740.  https://doi.org/10.1016/j.jvoice.2015.08.018 CrossRefPubMedGoogle Scholar
  17. 17.
    Koufman JA, Postma GN, Whang CS, Rees CJ, Amin MR, Belafsky PC, Johnson PE, Connolly KM, Walker FO (2001) Diagnostic laryngeal electromyography: the Wake Forest experience 1995–1999. Otolaryngol Head Neck Surg 124(6):603–606PubMedGoogle Scholar
  18. 18.
    Sataloff RT, Praneetvatakul P, Heuer RJ, Hawkshaw MJ, Heman-Ackah YD, Schneider SM, Mandel S (2010) Laryngeal electromyography: clinical application. J Voice 24(2):228–234.  https://doi.org/10.1016/j.jvoice.2008.08.005 CrossRefPubMedGoogle Scholar
  19. 19.
    Maamary JA, Cole I, Darveniza P, Pemberton C, Brake HM, Tisch S (2017) Relationship between laryngeal electromyography and video laryngostroboscopy in vocal fold paralysis. J Voice 31(5):638–642.  https://doi.org/10.1016/j.jvoice.2017.02.003 CrossRefPubMedGoogle Scholar
  20. 20.
    Foerster G, Mueller AH (2018) Laryngeal EMG: Preferential damage of the posterior cricoarytenoid muscle branches especially in iatrogenic recurrent laryngeal nerve lesions. Laryngoscope 128(5):1152–1156.  https://doi.org/10.1002/lary.26862 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Gerd Fabian Volk
    • 1
  • Sebastian Themel
    • 1
  • Markus Gugatschka
    • 2
  • Claus Pototschnig
    • 3
  • Christian Sittel
    • 4
  • Andreas H. Müller
    • 5
  • Orlando Guntinas-Lichius
    • 1
  • For the Working Group on Laryngology and Tracheal Diseases of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the Working Group on Neurolaryngology of the European Laryngological Society (ELS)
  1. 1.Department of Otorhinolaryngology, Institute of Phoniatry/PedaudiologyJena University HospitalJenaGermany
  2. 2.Department of Phoniatrics, ENT University Hospital GrazMedical University GrazGrazAustria
  3. 3.Department of OtorhinolaryngologyUniversity of InnsbruckInnsbruckAustria
  4. 4.Department of Otorhinolaryngology-Head and Neck SurgeryKatharinenhospitalStuttgartGermany
  5. 5.Department of OtorhinolaryngologySRH Wald-Klinikum GeraGeraGermany

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