Sulica Lucian, Blitzer Andrew
Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York, New York, USA.
Curr Opin Otolaryngol Head Neck Surg. 2007 Jun;15(3):159-62. doi: 10.1097/MOO.0b013e32814b0875.
To present and assess the current state of knowledge regarding vocal fold paresis.
Neurogenic compromise of vocal fold function exists along a continuum encompassing partial denervation (paresis), complete denervation (paralysis), and variable degrees and patterns of reinnervation. Not abundantly recognized clinically until recently, paresis typically presents with symptoms of glottic insufficiency. As a result of preserved vocal fold mobility, paresis can be difficult to diagnose and to distinguish from innocent vocal fold asymmetry. Laryngoscopy alone has proved an unreliable means of diagnosis, and laryngeal electromyography, although not immune to error itself, is often helpful. Treatment consists of medialization procedures that do not compromise remaining nerve function. Significant disagreement exists regarding the incidence, causes and relationship to other pathologies. In the absence of evidence, natural history must be inferred.
Vocal fold paresis is probably a significant source of vocal disability, especially among cases that have eluded straightforward diagnosis. An accurate assessment of its clinical impact, patterns of dysfunction, natural history and relationship to other pathologies depends on diagnostic rigor and accuracy and is still evolving.
介绍并评估目前关于声带麻痹的知识现状。
声带功能的神经源性损害存在一个连续过程，包括部分失神经支配（麻痹）、完全失神经支配（瘫痪）以及不同程度和模式的再支配。直到最近才在临床上得到广泛认识，麻痹通常表现为声门闭合不全的症状。由于声带仍有活动度，麻痹可能难以诊断，也难以与良性声带不对称相鉴别。单独的喉镜检查已被证明是一种不可靠的诊断方法，而喉肌电图虽然本身也并非完全没有误差，但通常很有帮助。治疗包括不损害剩余神经功能的内移手术。关于发病率、病因以及与其他病理学的关系存在重大分歧。在缺乏证据的情况下，必须推断其自然病程。
声带麻痹可能是导致嗓音残疾的一个重要原因，尤其是在那些难以直接诊断的病例中。对其临床影响、功能障碍模式、自然病程以及与其他病理学的关系进行准确评估，取决于诊断的严谨性和准确性，并且仍在不断发展。
