Diagnosis of vocal fold paresis: current opinion and practice.
OBJECTIVE
No accepted standard exists for the diagnosis of vocal fold paresis (VFP). Laryngeal specialists are surveyed to establish expert opinion on diagnostic methodology and criteria.


METHODS
Cross-sectional survey.


METHODS
Questionnaires were distributed at laryngology conferences in fall 2013. Responses were collated anonymously and subjected to cross-tabulated data analysis.


RESULTS
Fifty-eight responses completed by posttraining physicians whose practice focused in laryngology ≥ 75% were analyzed. One (1.7%) relied principally on laryngeal electromyography, one (1.7%) on history, 10 (17%) on laryngoscopy, and 42 (72%) on strobovideolaryngoscopy for diagnosis. Only 12 (21%) performed laryngeal electromyography on > 50% of vocal fold paresis patients. Laryngeal electromyography sensitivity was considered moderate (61 ± 3.7%, σ = 28). Laryngoscopic/stroboscopic findings considered to have the strongest positive predictive value for VFP were slow/sluggish vocal fold motion (75 ± 3.0%, σ = 23), decreased adduction (67 ± 3.5%, σ = 27), decreased abduction (65 ± 3.4%, σ = 26), and decreased vocal fold tone (61 ± 3.5%, σ = 26). Asymmetric mucosal wave amplitude (52 ± 4.2%, σ = 32), asymmetric mucosal wave phase (60 ± 4.1%, σ = 31), hemilaryngeal atrophy (60 ± 4.0%, σ = 31), and asymmetric mucosal wave frequency (49 ± 4.0%, σ = 30) generated greatest disagreement.


CONCLUSIONS
Surveyed expert laryngologists diagnose vocal fold paresis predominantly on stroboscopic examination. Gross motion abnormalities had the highest positive predictive value. Laryngeal electromyography was infrequently used to assess for vocal fold paresis.
New York Center for Voice and Swallowing Disorders, Department of Otolaryngology-Head and Neck Surgery, St Luke's-Roosevelt Hospital, New York, New York, U.S.A.
Amy P
AP
Wu
Lucian
L
Sulica
D003430:Cross-Sectional Studies; D004576:Electromyography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007828:Laryngoscopy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000639:trends; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D049489:Stroboscopy / Q000379:methods / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014826:Vocal Cord Paralysis / Q000175:diagnosis*
Vocal fold paresis; laryngeal electromyography; laryngoscopy; stroboscopy