Abstract
Purpose
To estimate the incidence of “innocent” arytenoid adduction asymmetry (AAA) among patients presenting at a laryngology clinic, identify its association with demographic characteristics, symptomatology and various clinical/pathological conditions and thereby determine its clinical significance.
Methods
A prospective comparative observational clinical study was conducted. Group 1 included patients presenting at the Department of Laryngology, identified with a primary diagnosis and coexisting “innocent” AAA i.e., an overriding arytenoid with normal vocal fold mobility on laryngoscopy. Group 2 included an equal number of randomly selected patients fulfilling the same criteria, without AAA. Demographic and clinical details were recorded and analyzed.
Results
110 cases were included in each group. The incidence of innocent AAA was 12.7%. Males were predominant in both Groups, with the gender difference significant in Group 1. Patients in Group 1 were significantly younger than in Group 2. Professional voice users, namely singers, were significantly greater in Group 1. Symptoms associated with Group 1 (i.e. AAA) were high pitch strain while singing (p = 0.01) and unilateral throat pain (p = 0.01), and the associated diagnoses were Singing Voice Dysphonia (p = 0.005), Vocal Process Granuloma (p = 0.04) and Ventricular Band Dysphonia (p = 0.047). As a definitive diagnosis was made in all patients, the presenting complaints were not attributed to AAA. Right sided preponderance of AAA was significant. Among the diagnoses with a laterality (e.g. vocal process granuloma), AAA was observed contralateral to the pathology in 70.7% and ipsilaterally in 29.3% (p = 0.0058).
Conclusion
Innocent AAA is common among males in the 3rd–4th decades, in singers among professional voice users, and in those with the muscle tension dysphonia spectrum and vocal process granuloma, thereby suggesting that it is an acquired habit/response to greater vocal demand. The observation of AAA contralateral to laryngeal lesions, highlights its compensatory nature, attempting to optimize glottic closure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of data and material
Compiled and archived.
References
Clarós P, Clarós-Pujol A, Clarós A (2018) Arytenoid asymmetry in opera singers. Eur Ann Otorhinolaryngol Head Neck Dis 135(6):389–392
Letson JA, Tatchell R (2005) Arytenoid movement. In: Sataloff RT (ed) Professional voice: the science and art of clinical care III, 3rd edn. Plural Publishing, San Diego, pp 179–192
Hirano M, Yukizane K, Kurita S, Hibi S (1989) Asymmetry of the laryngeal framework: a morphologic study of cadaver larynges. Ann Otol Rhinol Laryngol 98(2):135–140
Husseini ST, Ashkar J, Halawi A, Sibai A, Hamdan AL (2011) Arytenoid asymmetry in relation to posture, neck tension and glottal attack in singers. Folia Phoniatr Logop 63(5):264–268
Bonilha HS, O’Shields M, Gerlach TT, Deliyski DD (2009) Arytenoid adduction asymmetries in persons with and without voice disorders. Logop Phoniatr Vocol 34(3):128–134
Sulica L (2013) Vocal fold paresis: an evolving clinical concept. Curr Otorhinolaryngol Rep 1(3):158–162
Zan E, Yousem DM, Aygun N (2011) Asymmetric mineralization of the arytenoid cartilages in patients without laryngeal cancer. Am J Neuroradiol 32(6):1113–1118
Lindestad PÅ, Hertegård S, Björck G (2004) Laryngeal adduction asymmetries in normal speaking subjects. Logop Phoniatr Vocol 29(3):128–134
Hamdan AL, Husseini ST, Halawi A, Sibai A (2011) Arytenoid asymmetry in relation to vocal symptoms in singers. J Voice 25(2):241–244
Tarafder KH, Datta PG, Tariq A (2012) The aging voice. Bangabandhu Sheikh Mujib Med Univ J 5(1):83–86
Al-Dousary S (1997) Vocal process granuloma. Ear Nose Throat J 76(6):382–387
Lacina O (1970) Die adduktionelle Asymmetrie des Kehlkopfes bei den Sängern (Asymmetria arytenoidea cruciata cantatorum). Folia Phoniatr 22(2):100–106
Friedrich G, Kainz J, Schneider GH, Anderhuber F (1989) Computed tomography of the larynx in the diagnosis of dysphonia. Folia Phoniatr (Basel) 41(6):283–291
Hamdan AL, Nassar J, Ashkar J, Sibai A (2011) Prevalence of arytenoid asymmetry in relation to vocal symptoms. J Laryngol Otol 125(3):282–287
Van Houtte E, Van Lierde K, Claeys S (2011) Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice 25:202–207
Mahajan P (2009) Use of social networking in a linguistically and culturally rich India. Int Inf Lib Rev 41(3):129–136
Funding
The authors declare that they have no funding source or financial relationships.
Author information
Authors and Affiliations
Contributions
Each author listed on the manuscript has contributed to the study, has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval
All procedures performed in this study on human participants were in accordance with the ethical standards of the affiliated Institutional research committee and with the 1964 Helsinki declaration and its later amendments and comparable ethical standards.
Informed consent
All participants provided written informed consent.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Mathew, A.S., Menon, J.R. “Innocent” arytenoid adduction asymmetry: An etiological survey. Eur Arch Otorhinolaryngol 278, 427–435 (2021). https://doi.org/10.1007/s00405-020-06352-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-020-06352-6