gms | German Medical Science

100 Jahre Phoniatrie in Deutschland
22. Wissenschaftliche Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie
24. Kongress der Union Europäischer Phoniater

Deutsche Gesellschaft für Phoniatrie und Pädaudiologie e. V.

16. bis 18.09.2005, Berlin

Vocal fold paralysis imitated by arytenoid dislocation

Die Aryluxation imitierende Stimmlippen-Paralyse

Vortrag

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  • corresponding author presenting/speaker Libor Cerny - Phoniatric Dept. of the 1st Medical Faculty of the Charles University, Prague, The Czech Republic

100 Jahre Phoniatrie in Deutschland. 22. Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie, 24. Kongress der Union der Europäischen Phoniater. Berlin, 16.-18.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05dgppV38

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgpp2005/05dgpp086.shtml

Veröffentlicht: 15. September 2005

© 2005 Cerny.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Abstract

Arytenoid dislocations are up to now frequently unrecognised and regarded as vocal fold paralyses although their early diagnostic determination is a condition for successful treatment. A case studies of 2 adult patients are demonstrated where were diagnosed anterior resp. posterior arytenoid dislocations after abdomen surgery resp. thyroid gland surgery. There are documented videolaryngostroboscopy (Kay Elemetrics Corp. 9100B) and electromyography (Dantec Counterpoint) results in both subjects as well as voice recording with multidimensional voice analysis (Kay Elemetrics Computer Speech Laboratory). The study is concentrated on necessity of electromyography evaluation as there is no specific stroboscopy finding for recurrens paralysis distinguishing.


Text

Introduction

Arytenoid dislocations are up to now frequently unrecognised and regarded as vocal fold paralyses although their early diagnostic determination is a condition for successful treatment [1].

Methods

There was obtained a detail patient history, than an examination by video-laryngostroboscope (Kay Elemetrics Corp. RLS 9100 B) with an electroglottographic synchronisation and voice-sound recording. According to stroboscopic results there were electromyographic examinations indicated (Dantec Counterpoint Mk 2). Spontaneous activity and the activity pattern at voluntary contraction in cricothyroid and thyroarytenoid muscles was registered by needle electrodes.

Results

Case 1:

23-year-old female with no history of voice disorder before a cardiopulmonary resuscitation (CPR) in the age of 14 years. After CPR, with an intubation and a tracheotomy, a severe dysphonia (aphonia) has occurred. It was misdiagnosed by GP, ENT and specialists in phoniatry too as various forms of functional voice disorders or vocal fold paralyses. There was even indicated psychotherapy.

After 7 years there was a videolaryngostroboscopic examination here and then was EMG provided. A normal activity pattern in both of cricothyroid and thyroarytenoid muscles was registered. After 7 years due to long time arytenoid immobility an effort to surgical repair was unsuccessful.

Case 2:

61-year-old female with no history of voice disorder before a thyroid gland surgery (carried out 3 month before an examination here). According to surgical report there was an extremely difficult intubation. A mild dysphonia has occured after surgery. Specialist in ENT diagnosed left-side vocal fold paralysis and ask for voice rehabilitation.

The voice was weak with higher breathiness, without diplophony, maximum phonation time 5 sec, the left vocal fold completely immobile in the intermedian position.

Figure 1 [Fig. 1], Figure 2 [Fig. 2].

EMG examination (3 month after surgery) has shown a normal pattern at voluntary contraction in both of cricothyroid (n.laryngeus superior) and thyroarytenoid (n.laryngeus recurrens) muscles and no pathologic spontaneous activity. It confirmed a suspicion of arytenoid dislocation and a surgical reposition was recommended.

Conclusions

We can see the necessity of electromyography examination also in seemingly clear cases of "vocal fold paralyses"- as with a history of thyroid gland surgery. There is no specific stroboscopy finding for arytenoid dislocation and n.laryngeus recurrens paralysis distinguishing. A late diagnosis of arytenoid dislocation can make a surgery treatment impossible.


References

1.
Sataloff, RT., Bough, ID., Spiegel, JR. 1994. Arytenoid dislocation: diagnosis and treatment. Laryngoscope, 104(10): 1353-1361
2.
Aronson, EA. 1996. Clinical Voice Disorders. New York, Thieme
3.
Teitler, N. 1995. Examiner bias: Influence of patient history on perceptual ratings of videostroboscopy. Journal of Voice, 9(1): 95-105
4.
Ludin, HP. 1980. Electromyography in Practice. New York, Thieme-Stratton, Inc., 48-69
5.
Keller, O. 1999. Obecna elektromyografie. (in Czech), Prague, Triton, 73-85