Spataro Emily A, Grindler David J, Paniello Randal C
Department of Otolaryngology-Head and Neck Surgery, Washington, University School of Medicine, St Louis, Missouri, USA.
Department of Otolaryngology-Head and Neck Surgery, Washington, University School of Medicine, St Louis, Missouri, USA
Otolaryngol Head Neck Surg. 2014 Aug;151(2):286-93. doi: 10.1177/0194599814531733. Epub 2014 May 5.
To determine the etiology, laterality, and time to presentation of unilateral vocal fold paralysis (UVFP) at a tertiary care institution over 10 years.
Case series with chart review.
Academic medical center.
All patients seen between 2002 and 2012 by the Department of Otolaryngology at the Washington University School of Medicine (WUSM), with a diagnosis of unilateral vocal fold paralysis, were included. Medical records were reviewed for symptom onset date, presentation date(s), and etiology of UVFP.
Of the patients, 938 met inclusion criteria and were included. In total, 522 patients (55.6%) had UVFP due to surgery; 158 (16.8%) were associated with thyroid/parathyroid surgery, while 364 (38.8%) were due to nonthyroid surgery. Of the patients, 416 (44.4%) had nonsurgical etiologies, 124 (13.2%) had idiopathic UVFP, and 621 (66.2%) had left-sided UVFP. The diagnosis was more common on the left side in cases of intrathoracic surgeries and malignancies, as expected, but also in idiopathic, carotid endarterectomy, intubation, and skull base tumors. In total, 9.8% of patients presented first to an outside otolaryngologist at a median time of 2.1 months after onset, but these patients presented to WUSM at a median time of 9.5 months. Overall, 70.6% of patients presented to a WUSM otolaryngologist within 3 months of onset.
Iatrogenic injury remains the most common cause of UVFP. Thyroidectomy remains the leading cause of surgery-related UVFP. Patients are typically seen within 3-4 months of onset; however, a significant delay exists for those referred to WUSM.
确定一家三级医疗机构10年间单侧声带麻痹（UVFP）的病因、患侧及就诊时间。
病例系列研究并进行病历回顾。
学术医疗中心。
纳入2002年至2012年间在华盛顿大学医学院（WUSM）耳鼻喉科就诊且诊断为单侧声带麻痹的所有患者。查阅病历以获取症状起始日期、就诊日期及单侧声带麻痹的病因。
938例患者符合纳入标准并被纳入研究。总计，522例患者（55.6%）的单侧声带麻痹由手术引起；158例（16.8%）与甲状腺/甲状旁腺手术相关，而364例（38.8%）由非甲状腺手术导致。416例患者（44.4%）有非手术病因，124例（13.2%）为特发性单侧声带麻痹，621例（66.2%）为左侧单侧声带麻痹。正如预期，在胸腔内手术和恶性肿瘤病例中，左侧诊断更为常见，但在特发性、颈动脉内膜切除术、插管及颅底肿瘤病例中也是如此。总计，9.8%的患者在症状起始后中位时间2.1个月时首先就诊于外院耳鼻喉科医生，但这些患者在中位时间9.5个月时就诊于WUSM。总体而言，70.6%的患者在症状起始后3个月内就诊于WUSM耳鼻喉科医生。
医源性损伤仍是单侧声带麻痹最常见的病因。甲状腺切除术仍是手术相关单侧声带麻痹的主要原因。患者通常在症状起始后3 - 4个月内就诊；然而，转诊至WUSM的患者存在显著延迟。
