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Eur Arch Otorhinolaryngol. 2018 Oct;275(10):2535-2540. doi: 10.1007/s00405-018-5102-5. Epub 2018 Aug 23.

Vocal fold paresis: Medical specialists' opinions on standard diagnostics and laryngeal findings.

Author information

1
Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
2
Department of Phoniatrics, ENT University Hospital Graz, Medical University Graz, Graz, Austria.
3
Department of Otorhinolaryngology, University of Innsbruck, Innsbruck, Austria.
4
Department of Otorhinolaryngology-Head and Neck Surgery, Katharinenhospital, Stuttgart, Germany.
5
Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany.
6
Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany. orlando.guntinas@med.uni-jena.de.

Abstract

PURPOSE:

There is still no clear consensus on the diagnostic value of specific laryngeal findings in patients with suspected vocal fold paresis (VFP). The aim of the study was to establish expert opinion on criteria for the diagnosis of VFP in Europe.

METHODS:

A cross-sectional survey using the questionnaire introduced by Wu and Sulica for US American experts was addressed to laryngeal experts in Germany, Austria, and Switzerland and in a second survey wave to members of the European Laryngological Society.

RESULTS:

100 respondents returned survey 1 (response rate 47.2%). 26% worked at a university department. 28% regularly used laryngeal electromyography (LEMG). A pathologic test results in LEMG was considered to have the strongest positive predictive value for VFP (79 ± 23%), followed by a decreased vocal fold abduction (70 ± 29%), decreased vocal fold adduction (61 ± 34%), and atrophy of the hemilarynx (61 ± 31%). The multivariate analysis showed the predictive value of LEMG was estimated lower by respondents from non-university hospital (β = - 16.33; confidence interval (CI) = - 25.63 to - 7.02; p = 0.001) and higher in hospitals with higher frequency of VFP patients per months (β = 1.57; CI = - 0.98 to 2.16; p < 0.0001). 30 ELS members returned survey 2 (response rate, 8.4%). Their answers were not significantly different to survey 1.

CONCLUSIONS:

The laryngology experts in Europe rely on LEMG for diagnosis of VFP like the US American experts, but paradoxically only a minority uses LEMG frequently. Next to LEMG, motion abnormities were considered to have the best predictive value for the diagnosis of VFP.

KEYWORDS:

Laryngeal electromyography; Laryngoscopy; Laryngostroboscopy; Neurolaryngology; Survey; Vocal fold immobility; Vocal fold motion; Vocal fold paralysis; Vocal fold paresis

PMID:
30141109
DOI:
10.1007/s00405-018-5102-5
[Indexed for MEDLINE]

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