Unilateral Vocal Fold Immobility (UVFI)

Epidemiology

Incidence of Etiologies of Unilateral Vocal Fold Immobility (1996-2005 data per [MEDLINE])

  • Surgery (46.3% of cases)
    • Thyroid Surgery (26% of all surgical cases)
    • Other Surgery (17% of all surgical cases)
    • Anterior Cervical Spine Surgery (15% of all surgical cases)
    • Carotid Endarterectomy (11% of all surgical cases)
    • Lung Biopsy/Resection (8% of all surgical cases)
    • Parathyroid Surgery (6% of all surgical cases)
    • Intracranial Surgery (5% of all surgical cases)
    • Aortic Aneurysm Surgery (5% of all surgical cases)
    • Heart Valve Surgery (4% of all surgical cases)
    • Skull Base Surgery: accounts for 2% of all surgical cases)
    • Thyroid and Parathyroid Surgery, Combined (1% of all surgical cases)
  • Idiopathic (17.6% of cases)
  • Malignancy (13.5% of cases)
    • Lung Cancer (6.6% of cases)
    • Metastatic Cancer (3.3% of cases)
    • Thyroid Cancer (2.2% of cases)
    • Other Cancer (0.8% of cases)
    • Esophageal Cancer (0.6% of cases)
  • Other (5.2% of cases)
  • Intubation (4.4% of cases)
  • Infection (3.6% of cases)
  • CNS Disease (3.0% of cases)
  • Trauma (2.2% of cases)
  • Inflammation (1.9% of cases)

Incidence of Etiologies of Bilateral Vocal Fold Immobility (1996-2005 data per [MEDLINE])

  • Surgery (55.6% of cases)
    • Thyroid Surgery (48% of all all surgical cases)
    • Thyroid and Parathyroid Surgery, Combined (13% of all surgical cases)
    • Parathyroid Surgery (29% of all surgical cases)
    • Carotid Endarterectomy (5% of all surgical cases)
    • Heart Surgery (5% of all surgical cases)
  • Malignancy (9.7% of cases)
    • Lung Cancer (4.2% of cases)
    • Metastatic Cancer (2.8% of cases)
    • Other Cancer (1.4% of cases)
    • Esophageal Cancer (1.4% of cases)
    • Thyroid Cancer (0% of cases)
  • Intubation (9.7% of cases)
  • Idiopathic (8.3% of cases)
  • CNS Disease/Neuropathy (6.9% of cases)
  • Stenosis (2.8% of cases)
  • Infection (1.4% of cases)
  • Inflammation (1.4% of cases)
  • Trauma (1.4% of cases)
  • Radiation (1.4% of cases)
  • Other (1.4% of cases)

Etiology

  • Cervical malignancy: encroachment on recurent laryngeal nerve (usually left)
  • Mediastinal mass: encroachment on recurrent laryngeal nerve (usually left)
  • Aortic aneurysm: encroachment on recurrent laryngeal nerve (usually left)
  • Post-intubation: may cause cricoarytenoid fixation, glottic web, interstitial fibrosis (all simulate paralysis of cord)
  • Idiopathic unilateral vocal cord paralysis:

Physiology

  • Paralyzed cord is near midline

Diagnosis

  • ABG: PFT’s: usually normal
  • Fiberoptic Bronchoscopy: reveals paralyzed cord (usually left side)
  • Pulmonary Function Tests
  • Fiberoptic Laryngoscopy
  • Laryngeal Electromyogram (EMG)

Clinical

  • Unlikely to produce significant upper airway obstruction
  • Hoarseness: usually present
  • Aspiration with Laryngospasm During Sleep: may occur

Treatment

  • Midline Repositioning of Vocal Cord: using injected silicone

References

  • Changing etiology of vocal fold immobility. Laryngoscope 1998;108(9):1346-1350 [MEDLINE]
  • The nasogastric tube syndrome. Laryngoscope. 1990 Sep;100(9):962-8 [MEDLINE]
  • Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope. 2007 Oct;117(10):1864-70 [MEDLINE]