Bilateral vocal fold paresis and multiple system atrophy

Abstract

Objective: To review a case series of patients with systemic neurodegenerative disease presenting to a laryngologist for workup of dysphonia and found to have bilateral vocal fold paresis. Design: Case series. Setting: Tertiary care voice center. Patients: Series of patients with neurodegenerative disorders examined for dysphonia. Main Outcome Measures: History and physical examination including fiberoptic laryngoscopy were performed on all patients. Some patients underwent polysomnography. Results: Seven patients during a 2-year period were noted to have bilateral abductor vocal fold paresis. Five of 7 (71%) had the diagnosis of multiple system atrophy proposed by the laryngologist. All 7 patients described sleep-disordered breathing with stridor. Conclusions: Patients with systemic neurodegenerative disorders such as Parkinson disease should be examined for multiple system atrophy and for evidence of bilateral vocal fold paresis. Workup for stridor should include polysomnography. Treatment of glottic obstruction in these patients includes constant positive airway pressure at night or tracheotomy. The finding of bilateral vocal fold paresis can be life threatening.