Maamary Joel A, Cole Ian, Darveniza Paul, Pemberton Cecilia, Brake Helen Mary, Tisch Stephen
School of Medicine, University of Notre Dame, Sydney, Australia.
Department of Laryngology, The St Vincent's Hospital, Sydney, Australia; Voice Assessment Centre, The St Vincent's Clinic, Sydney, Australia.
J Voice. 2017 Sep;31(5):638-642. doi: 10.1016/j.jvoice.2017.02.003. Epub 2017 Mar 17.
OBJECTIVES/HYPOTHESIS: The objective of this study was to better define the relationship of laryngeal electromyography and video laryngostroboscopy in the diagnosis of vocal fold paralysis.
Retrospective diagnostic cohort study with cross-sectional data analysis METHODS: Data were obtained from 57 patients with unilateral vocal fold paralysis who attended a large tertiary voice referral center. Electromyographic findings were classified according to recurrent laryngeal nerve, superior laryngeal nerve, and high vagal/combined lesions. Video laryngostroboscopy recordings were classified according to the position of the immobile fold into median, paramedian, lateral, and a foreshortened/hooded vocal fold. The position of the paralyzed vocal fold was then analyzed according to the lesion as determined by electromyography.
The recurrent laryngeal nerve was affected in the majority of cases with left-sided lesions more common than right. Vocal fold position differed between recurrent laryngeal and combined vagal lesions. Recurrent laryngeal nerve lesions were more commonly associated with a laterally displaced immobile fold. No fold position was suggestive of a combined vagal lesion. The inter-rater reliability for determining fold position was high.
Laryngeal electromyography is useful in diagnosing neuromuscular dysfunction of the larynx and best practice recommends its continued implementation along with laryngostroboscopy. While recurrent laryngeal nerve lesions are more likely to present with a lateral vocal fold, this does not occur in all cases. Such findings indicate that further unknown mechanisms contribute to fold position in unilateral paralysis.
目的/假设：本研究的目的是更好地明确喉肌电图和视频喉动态镜检查在声带麻痹诊断中的关系。
采用回顾性诊断队列研究及横断面数据分析方法
数据来自于57例单侧声带麻痹患者，这些患者均就诊于一家大型三级嗓音转诊中心。根据喉返神经、喉上神经及高位迷走神经/联合病变对肌电图检查结果进行分类。根据静止声带的位置，将视频喉动态镜检查记录分为正中位、旁正中位、外侧位及声带缩短/呈帽状位。然后根据肌电图确定的病变情况，分析麻痹声带的位置。
大多数病例中喉返神经受累，左侧病变比右侧更为常见。喉返神经病变和迷走神经联合病变的声带位置不同。喉返神经病变更常与外侧移位的静止声带相关。没有一种声带位置提示迷走神经联合病变。确定声带位置的观察者间信度较高。
喉肌电图有助于诊断喉部神经肌肉功能障碍，最佳实践建议其与喉动态镜检查一起继续应用。虽然喉返神经病变更可能表现为声带外侧移位，但并非所有病例均如此。这些发现表明，在单侧麻痹中，还有其他未知机制影响声带位置。
