Vocal Fold Paresis: An Evolving Clinical Concept

Abstract

Neurogenic compromise of vocal fold function exists along a continuum encompassing variable degrees and patterns of partial denervation (paresis). Not abundantly recognized until recently, vocal fold paresis is probably a significant source of vocal disability, especially among cases that have eluded straightforward diagnosis. It presents with symptoms of glottic insufficiency, and probably follows a clinical course analogous to that of paralysis. As a result of preserved gross mobility, paresis can be difficult to diagnose and distinguish from innocent asymmetries of laryngeal motion. Both laryngoscopy/stroboscopy and electromyography are useful in diagnosis despite both of them having important limitations. Because of these, trials of treatment are uniquely useful in vocal fold paresis. Significant disagreement persists regarding incidence, causes, signs, and association with other diseases. Treatment consists of medialization and/or augmentation procedures that do not compromise remaining neural function.