title: Vocal fold motion impairment in multiple system atrophy.
abstract: OBJECTIVE
  Multiple system atrophy (MSA) is a degenerative neurologic disorder that can affect vocal fold mobility. Our aim was to further elucidate the impact of vocal fold motion impairment (VFMI) in MSA.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  We undertook a retrospective review of all MSA patients reporting voice or respiratory symptoms from 1975 to 2010 at Mayo Clinic Rochester who also received otolaryngologic examination.
  
  
  RESULTS
  Thirty-eight MSA patients demonstrated VFMI. Median duration of vocal or respiratory symptoms prior to diagnosis of MSA was 12.0 months (range, 1-60 months). Stridor was present in 25 (68%) of patients. There was bilateral VFMI in 32 (82.4%) of the patients and isolated VFMI of the left true vocal fold (TVF) in six (17.6%) of the patients. No patients had isolated right VFMI. There was isolated unilateral or bilateral paresis in 21 (55.3%) of the patients and unilateral or bilateral complete paralysis in 15 (39.5%) of the patients. One patient presented with left TVF paralysis and right TVF paresis, whereas one other patient had findings of right TVF paralysis and left TVF paresis comprising the remaining 5.2% of patients with VFMI. The median survival after diagnosis of VFMI was 51.6 months. Unilateral or bilateral TVF paralysis was statistically associated with a decreased overall survival (P = .0384). The presence of stridor was not associated with adverse prognosis.
  
  
  CONCLUSIONS
  The increasing severity of VFMI negatively impacts overall survival in patients with MSA. Therefore, otolaryngologic examination is warranted at the time of MSA diagnosis.
authors.affiliation: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Lalich
authors.forename: Dale C
authors.initials: DC
authors.lastname: Ekbom
authors.forename: Sidney J
authors.initials: SJ
authors.lastname: Starkman
authors.forename: Diana M
authors.initials: DM
authors.lastname: Orbelo
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014826:Vocal Cord Paralysis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D014827:Vocal Cords / Q000503:physiopathology*
keywords: Multiple system atrophy; hoarseness; stridor; sudden death; vocal fold motion impairment