Benninger M S, Gillen J B, Altman J S
Department of Otolaryngology, Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan 48202-2689, USA.
Laryngoscope. 1998 Sep;108(9):1346-50. doi: 10.1097/00005537-199809000-00016.
Vocal fold immobility is a sign of underlying disease. When the etiology remains unclear, evaluation may become time consuming and costly, and directed work-up imperative. This study examined the hypothesis that the etiologies of vocal fold immobility are changing, with extralaryngeal malignancies and nonthyroidectomy surgical trauma having become more common causes.
A retrospective review of consecutive patients with vocal fold immobility who had an adequate workup to determine the etiology.
Three hundred ninety-seven cases with a determined etiology were identified, yielding 280 unilateral and 117 bilateral immobilities. The largest single category in unilateral immobility was nonlaryngeal malignancy--69 patients (24.7%)--80% of which were pulmonary or mediastinal, followed by 67 patients (23.9%) with immobility secondary to surgical trauma. Thyroidectomy accounted for only 8.2%. The leading cause of bilateral immobility was surgical trauma-30 patients (25.7%)--21 (18%) of whom had thyroidectomy. Acute and chronic intubation injuries accounted for 21 unilateral (7.5%) and 18 bilateral (15.4%) cases.
These data indicate a changing etiology of vocal fold immobility, with growing percentages of extralaryngeal malignancies and surgery-related injuries. These findings have implications for the timing and method of management based on anticipated outcome.
声带固定是潜在疾病的一种体征。当病因不明时，评估可能耗时且成本高昂，因此有必要进行针对性检查。本研究检验了以下假说：声带固定的病因正在发生变化，喉外恶性肿瘤和非甲状腺切除手术创伤已成为更常见的病因。
对连续的声带固定患者进行回顾性研究，这些患者均接受了充分检查以确定病因。
共确定了397例病因明确的病例，其中280例为单侧声带固定，117例为双侧声带固定。单侧声带固定中最大的单一类别是非喉恶性肿瘤——69例患者（24.7%）——其中80%为肺部或纵隔肿瘤，其次是67例（23.9%）因手术创伤导致声带固定的患者。甲状腺切除术仅占8.2%。双侧声带固定的主要原因是手术创伤——30例患者（25.7%）——其中21例（18%）接受了甲状腺切除术。急性和慢性插管损伤分别导致21例单侧（7.5%）和18例双侧（15.4%）声带固定。
这些数据表明声带固定的病因正在发生变化，喉外恶性肿瘤和手术相关损伤的比例不断增加。这些发现对基于预期结果的治疗时机和方法具有启示意义。
