Assistant Professor, Laryngologist Medstar Georgetown University Hospital, Veterans Affairs Medical Center of Washington DC Washington, District of Columbia
Objective: Laryngoscopy corresponding with appropriate laryngeal electromyography (LEMG) is essential in diagnosing vocal fold paresis (paresis). However, baseline asymmetry or other diseases can oftentimes confound the exam making the diagnosis difficult. There is currently no agreed upon endoscopic criteria that has proven to reliably correlate with LEMG findings. Our objective was to define a set of endoscopic findings termed “paresis triad”, that when present together, may reliably correlate with LEMG. The paresis triad consists of (1) ipsilateral (or weak side) vocal fold (VF) hypocontraction with increased ventricular show, (2) contralateral hypercontraction/bulging of the false VF covering the ventricle, and (3) interaytenoid cleft tilting to the ipsilateral side.
Methods: We performed a retrospective review of patients with laryngeal asymmetry on laryngoscopy. Patients were divided into two groups, those with consistent triad and those without. All patients underwent LEMG by a clinician blinded to their laryngoscopic findings.
Results: Twelve patients met inclusion criteria (age 50 +/-15, 7F:5M), nine with the paresis triad and three with inconsistent findings. All patients with the paresis triad had LEMG findings consistent with neurologic injury on the suspected side. Each of the three patients with inconsistent paresis triad had normal LEMG.
Conclusions: These findings suggest that the proposed laryngoscopic findings of paresis triad may be useful as objective criteria to diagnose paresis without the need for LEMG. Further prospective studies should examine larger series of patients.