What findings do laryngologists consider significant in the diagnosis of vocal fold (VF) paresis using strobolaryngoscopy, and which clinical signs are considered most compelling?
Bottom line
Most laryngologists use strobolaryngoscopy for paresis diagnosis. Although certain clinical findings were found to be associated with diagnosis, these varied among raters, especially when determining sidedness and nerve involvement.
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September 2017Background: A 2015 survey of 58 fellowship-trained laryngologists found that 89% of respondents diagnosed paresis predominantly on laryngoscopic examination, with 81% of this subset relying on stroboscopic light. Laryngoscopic and stroboscopic findings believed to have the strongest positive predictive value for paresis were VF motion anomalies (slow/sluggish VF motion: 75%; decreased adduction: 67%; and decreased abduction: 65%), and signs of VF degeneration (decreased VF tone: 61%). Determining which of these clinical signs is most compelling may help further clarify diagnosis.
The vocal folds in abduction and during phonatory adduction on rigid strobolaryngoscopic examination. Most examiners found a left-sided (97%) paresis involving the recurrent laryngeal nerve (74%). Examiners indicated decreased VF abduction, slow/sluggish VF movement, and decreased VF adduction as the most compelling clinical findings in diagnosis.
Credit: © The American Laryngological, Rhinological and Otological Society, Inc.
Study design: Retrospective cohort study of 34 videostroboscopic examinations (24 with paresis, eight without paresis, two repeats).