Parálisis unilateral de cuerda vocal de causa extralaríngea: etiología y pronóstico / Extralaryngeal causes of unilateral vocal cord paralysis: aetiology and prognosis

Introducción y metodología: La parálisis unilateral de cuerda vocal sin lesión laríngea asociada es una entidad relativamente frecuente. Puede ser la manifestación de numerosas enfermedades con origen en tórax, cuello, cráneo o sistémicas. El objetivo es estudiar la etiología extralaríngea de la parálisis unilateral de cuerda vocal, su pronóstico y la relación de ambas con distintas variables clínicas. Estudio retrospectivo de 116 pacientes con parálisis unilateral completa de cuerda vocal sin lesión laríngea asociada. Los pacientes fueron sometidos a tomografía computarizada (TC) cérvico-torácico +/– valoración por Servicio de Neurología con resonancia magnética (RM) cerebral para establecer la etiología y seguimiento de al menos 1 año.ResultadosLa causa extralaríngea más común de parálisis de cuerda vocal fue la yatrogénica tras cirugía cervical (46,5%), seguida de la tumoral (24,1%). Las parálisis idiopáticas resultaron el 15,5%. Se obtuvo relación entre el sexo y la etiología (p < 0,01), los varones en relación con la patología maligna y las mujeres con la yatrogénica. En los pacientes de edades avanzadas predomina la etiología cardiovascular, cerebrovascular, tumoral e idiopática; mientras que en los pacientes más jóvenes la quirúrgica (p < 0,01). El 18,1% recuperaron la movilidad de la cuerda vocal. El sexo femenino se relacionó con su recuperación (p < 0,01). El tabaco y la etiología maligna se relacionó con su persistencia (p < 0,01).ConclusionesLa primera causa extralaríngea de parálisis unilateral de CV es la quirúrgica seguido de las neoplasias de pulmón y tiroides. Existe gran diversidad de lesiones que pueden ocasionarla, en muchos casos supone el diagnóstico de tumores malignos. Su recuperación es más frecuente entre pacientes de sexo femenino, no fumadores y con patología de etiología benigna. (AU)

Introduction and methodology: Unilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases from the thorax, neck, skull or systemic. The objective is to study the extralaryngeal etiology of unilateral vocal cord paralysis, its prognosis and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT +/– evaluation by Neurology with brain MRI to establish the etiology and follow-up for at least 1 year.ResultsThe most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumor (24.1%). Idiopathic paralysis were 15.5%. An association was obtained between sex and etiology (p <0.01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumor and idiopathic etiology predominate in elderly patients; while in younger patients the surgical one (p <0.01). 18.1% recovered vocal cord mobility. The female sex was related to its recovery (p <0.01). Tobacco and malignant etiology were related to its persistence (p <0.01).ConclusionsThe first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause it, in many cases it involves the diagnosis of malignant tumors. Its recovery is more frequent in female patients, non-smokers and with benign pathology. (AU)

Extralaryngeal causes of unilateral vocal cord paralysis: Aetiology and prognosis.

INTRODUCTION AND METHODOLOGY: Unilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases of the thorax, neck, skull, or systemic disease. The objective is to study the extralaryngeal aetiology of unilateral vocal cord paralysis, its prognosis, and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT ±â€¯evaluation by Neurology with brain MRI to establish the aetiology and were followed-up for at least 1 year. RESULTS: The most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumour (24.1%). Idiopathic paralysis was the cause in 15.5%. An association was obtained between sex and aetiology (P < .01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumour and idiopathic aetiology predominated in elderly patients; while surgical aetiology predominated in younger patients (P < .01). A total of 18.1% recovered vocal cord mobility. The female sex was related to recovery (P < .01). Tobacco and malignant aetiology were related to persistence (P < .01). CONCLUSIONS: The first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause the condition, in many cases involving a diagnosis of malignant tumours. Recovery is more frequent in female patients, non-smokers and with benign pathology.

¿Qué nos aporta la estroboscopia en el diagnóstico de los trastornos de la voz? / What is the contribution of stroboscopy in the diagnosis of voice disorders?

En el tratamiento de los trastornos persistentes de la voz es aconsejable la actuación conjunta del otorrinolaringólogo/fonocirujano, foniatra y logopeda. El diagnóstico de las lesiones vocales es esencial para un enfoque terapéutico adecuado. La estroboscopia aporta datos funcionales útiles para decidir un tratamiento quirúrgico, logopédico o combinado. Hemos revisado nuestros casos intervenidos de fonocirugía de los últimos 5 años y analizado la correlación que existe entre el diagnóstico preoperatorio con estroboscopia y los hallazgos intraoperatorios. En el 90% de los casos, existe una concordancia entre ambos diagnósticos. Consideramos que la estroboscopia es un medio de exploración imprescindible para establecer la indicación terapéutica adecuada y orientar al cirujano para el tratamiento quirúrgico (AU)

The management of voice disorders requires a close collaboration between the throat surgeon and the speech therapy team. The diagnosis of cordal lesions is essential to an accurate therapy. Stroboscopy contributes functional information which is useful to decide between microsurgery, vocal reeducation or a combined treatment. We have reviewed our phonomicrosurgery cases for the past five years and analyzed the correlation between preoperative diagnosis obtained by stroboscopy and intraoperative findings. In 90% of cases there exists a relation between both diagnoses. We consider stroboscopy as an essential means of evaluation to establish an adequate management and guidance for surgical treatment (AU)

[What is the contribution of stroboscopy in the diagnosis of voice disorders?]. / Qué nos aporta la estroboscopia en el diagnóstico de los trastornos de la voz?

The management of voice disorders requires a close collaboration between the throat surgeon and the speech therapy team. The diagnosis of cordal lesions is essential to an accurate therapy. Stroboscopy contributes functional information which is useful to decide between microsurgery, vocal reeducation or a combined treatment. We have reviewed our phonomicrosurgery cases for the past five years and analyzed the correlation between preoperative diagnosis obtained by stroboscopy and intraoperative findings. In 90% of cases there exists a relation between both diagnoses. We consider stroboscopy as an essential means of evaluation to establish an adequate management and guidance for surgical treatment.