Syamal Mausumi N, Benninger Michael S
Cleveland Clinic-Head and Neck Institute, Cleveland, Ohio, USA.
Curr Opin Otolaryngol Head Neck Surg. 2016 Jun;24(3):197-202. doi: 10.1097/MOO.0000000000000259.
Vocal fold paresis is a complex, controversial, and unique clinical entity. Guidance in assessing and evaluating these patients is provided in this comprehensive review of the current literature discussing the varying clinical presentation, the broad differential and general prognosis.
Patients with vocal fold paresis can present with elements of hyperfunction, which can often mask an underlying paresis. As such, repetitive phonatory tasks and videostroboscopic examination are critical for the assessment of patients with a suspected paresis. When analyzing stroboscopic findings, anatomical and motion asymmetries can strongly suggest the presence of a paresis. However, it is important to remember that other disorders can sometimes mimic or create a visual asymmetry when a true paresis may not be present. Laryngeal electromyography (LEMG) can serve as a valuable adjunct to confirm a paresis with the most reliable indicator being a decreased recruitment pattern. The differential is vast, including infectious, iatrogenic, systemic rheumatologic, and neurologic conditions. LEMG along with time of onset and the underlying cause of the paresis can be valuable prognostic indicators.
Patients with paresis often present with symptoms of a hyperkinetic voice disorder. Regardless of the myriad of causes, their assessment hinges upon close clinical evaluation with videostroboscopy aided with LEMG.
声带麻痹是一种复杂、存在争议且独特的临床病症。本文对当前文献进行全面综述，讨论了不同的临床表现、广泛的鉴别诊断及总体预后，为评估和评价这些患者提供指导。
声带麻痹患者可能表现出功能亢进的症状，这常常会掩盖潜在的麻痹。因此，重复性发声任务和频闪喉镜检查对于疑似麻痹患者的评估至关重要。分析频闪喉镜检查结果时，解剖结构和运动不对称强烈提示麻痹的存在。然而，重要的是要记住，在可能不存在真正麻痹的情况下，其他疾病有时可能会模仿或造成视觉上的不对称。喉肌电图（LEMG）可作为一种有价值的辅助手段来确诊麻痹，最可靠的指标是募集模式降低。鉴别诊断范围广泛，包括感染性、医源性、全身性风湿性和神经系统疾病。LEMG以及麻痹的发病时间和潜在病因可能是有价值的预后指标。
麻痹患者常表现出运动过度性嗓音障碍的症状。无论病因众多，对他们的评估关键在于通过频闪喉镜检查并辅以LEMG进行密切的临床评估。
