Service d'otorhinolaryngologie et de chirurgie cervico-faciale, hôpital Européen-Georges-Pompidou, université Paris-Descartes-Sorbonne-Paris-Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
Service d'otorhinolaryngologie et de chirurgie cervico-faciale, hôpital Européen-Georges-Pompidou, université Paris-Descartes-Sorbonne-Paris-Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Jun;135(3):171-174. doi: 10.1016/j.anorl.2018.01.004. Epub 2018 May 7.
To analyze the characteristics of adult idiopathic unilateral vocal-fold paralysis.
Retrospective study of diagnostic problems, clinical data and recovery in an inception cohort of 100 adult patients with idiopathic unilateral vocal-fold paralysis (Group A) and comparison with a cohort of 211 patients with isolated non-idiopathic non-traumatic unilateral vocal-fold paralysis (Group B).
Diagnostic problems were noted in 24% of cases in Group A: eight patients with concomitant common upper aerodigestive tract infection, five patients with a concomitant condition liable to induce immunodepression and 11 patients in whom a malignant tumor occurred along the path of the ipsilateral vagus and inferior laryngeal nerves or in the ipsilateral paralyzed larynx. There was no recovery of vocal-fold motion beyond 51 months after onset of paralysis. The 5-year actuarial estimate for recovery differed significantly (P<0.0001): 53.2% in Group A versus 17.9% in Group B. In Group A, recovery occurred before the end of the second year following paralysis onset in 93% of cases. On univariate analysis, recovery in Group A was associated with younger age (P=0.0033), shorter time to consultation (P<0.0001), and absence of oncologic history (P<0.028). In case of non-recovery in Group A, malignant tumor along the ipsilateral vagus or inferior laryngeal nerve was found in 17.2% of cases, 81% of which manifesting during the 30 months following the onset of vocal-fold paralysis.
In non-traumatic vocal-fold paralysis in adult patients, without recovery of vocal-fold motion, a minimum three years' regular follow-up is recommended.
分析成人特发性单侧声带麻痹的特征。
对 100 例成人特发性单侧声带麻痹（A 组）和 211 例单纯非特发性非创伤性单侧声带麻痹（B 组）患者的诊断问题、临床资料和恢复情况进行回顾性研究，并进行比较。
A 组有 24%的患者存在诊断问题：8 例伴有上呼吸道感染，5 例伴有易引起免疫抑制的合并症，11 例同侧迷走神经和喉返神经或同侧麻痹声带路径内发生恶性肿瘤。麻痹后 51 个月以上无声带运动恢复。麻痹后 5 年的恢复率有显著差异（P<0.0001）：A 组为 53.2%，B 组为 17.9%。A 组中，93%的患者在麻痹后第二年结束前恢复。单因素分析显示，A 组的恢复与年龄较小（P=0.0033）、就诊时间较短（P<0.0001）和无肿瘤病史（P<0.028）有关。在 A 组中，如果没有恢复，同侧迷走神经或喉返神经旁的恶性肿瘤在 17.2%的病例中发现，其中 81%在声带麻痹发作后 30 个月内出现。
在成人非创伤性声带麻痹中，如果声带运动没有恢复，建议至少进行 3 年的定期随访。
