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Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis
Author(s) -
Estes Christine,
Sadoughi Babak,
Mauer Elizabeth,
Christos Paul,
Sulica Lucian
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26570
Subject(s) - paresis , medicine , laryngoscopy , stroboscope , larynx , confidence interval , surgery , audiology , intubation , electrical engineering , engineering
Objectives/Hypothesis To identify strobolaryngoscopic findings significant in the diagnosis of paresis. Study Design Retrospective cohort study. Methods Fellowship‐trained laryngologists reviewed 34 videostroboscopic examinations (24 with paresis, eight without paresis, two repeat). They indicated presence or absence of paresis, including side and type, degree of confidence in diagnosis, and ranked clinical findings that influenced diagnosis by order of importance. Fleiss's κ was used to assess inter‐rater agreement for paresis presence, side, and type. Clinical findings compelling in diagnosis were tabulated and described. Confidence levels for side and type were compared by analysis of variance/Kruskal‐Wallis tests and post hoc pairwise comparisons. Results Thirty‐one laryngologists completed the review. Inter‐rater agreement on presence or absence of paresis was fair at 0.334 (Fleiss's κ). Fourteen examinations were diagnosed with paresis by >70% of raters and considered strong paresis‐candidate exams. Diagnosis of paresis side and type were inconsistent, although with statistically significant differences in confidence ratings (unilateral vs. bilateral, recurrent laryngeal nerve [RLN] vs. superior laryngeal nerve [SLN], RLN vs. mixed RLN/SLN). Laryngoscopic and stroboscopic findings with the strongest association with paresis were vocal fold motion anomalies, vocal fold degeneration, glottic insufficiency, and mucosal wave anomalies. Conclusions Most laryngologists use strobolaryngoscopy for diagnosis of paresis. Although certain clinical findings were found to be associated with diagnosis, most commonly vocal fold motion anomalies, these varied among raters, especially when determining sidedness and nerve involvement. Future studies should expand the discussion and consideration of strobolaryngoscopic factors and adjunct functional and objective measures to develop a heuristic algorithm for diagnosis of paresis. Level of Evidence 4. Laryngoscope , 127:2100–2105, 2017