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]
