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)



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.


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.


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.


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.


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


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)


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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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