Vokal Kord Paralizilerinin, Klinik ve Etyolojik Değerlendirilmesi
GİRİŞ ve AMAÇ: Bu çalışmanın amacı, vokal kord paralizisini (VKP) tanımlamak ve etiyolojik nedenleri ortaya koymaktır. YÖNTEM ve GEREÇLER: Çalışma retrospektif bir çalışma olup, 101 hastadan oluşmaktadır. Bir yıl boyunca ses probleminden şikayetçi olan ve VKP tespit edilen hastalar bu çalışmaya dahil edildi. Hastalar yaşa, cinsiyete ve lezyon tarafına göre analiz edildi. Laringeal endoskopi ile vokal kord paralizisi saptanan hastalar klinik, radyolojik ve patolojik olarak etiyolojik tanı koymak için değerlendirildi. BULGULAR: Erkek/ kadın oranı 0.6/1 olarak saptandı. Bilateral VKP 28 hasta (27.7 %), tek taraflı VKP 73 hasta (72.3 %) olarak saptandı. Tek taraflı vokal kord paralizi hastaları arasında sol VKP 39 hasta (53.5 %), sağ VKP 34 hasta (46.5%) olarak saptandı. Cerrahi en sık neden tiroidektomi olarak saptandı (%42.5). Cerrahi olmayan nedenlerin en başında ise idiopatik VKP (%17.8) ikinci en sık neden olarak saptandı. TARTIŞMA ve SONUÇ: Bizim serimizde cerrahi müdahale (özellikle tiroid cerrahisi) en sık sebep olarak bulundu. VKP etyolojisinin belirlenmesi, prognoz ve ek hastalıkların tespiti açısından oldukça önemli olduğu düşünülmektedir.
Clinical and Etiological Evaluation of Vocal Cord Paralysis
INTRODUCTION: The purpose of this study was to identify patients of vocal cord paralysis (VFP) and to discussion the etiological diagnosis. METHODS: This retrospective study was included 101 patients. The patients complaining a voice problem for a year and whose VFP has been detected were including in this study. We analysed them according to age, gender and side of the lesion. The patients identified with vocal cord paralysis by laryngeal endoscopy were evaluated clinically, radiologically and pathologically to make an etiological diagnosis. RESULTS: Males out numbered females in the ratio 0.6: 1. Bilateral VFP was found in 28 (27.7 %) patients. Unilateral VFP was found in 73 (72.3 %) patients. In patients with unilateral VFP 39 (53.5 %) patients had left and 34 (46.5 %) patients had right vocal cord. Thyroidectomy was the most common surgical cause of VFP (%42.5). At the beginning of the non-surgical causes, idiopathic VFP (17.8%) was the second most common cause. DISCUSSION AND CONCLUSION: In this study, surgical intervention (especially thyroid surgery) was the most common cause in our series. VFP is one of the most common cause of voice problem and identifying the etiology is crucial to determine the prognosis and additional diseases.
___
- 1. Rosenthal LH, Benninger MS, Deeb RH. Vocal
fold immobility a longitudinal analysis of
etiology over 20 years. Laryngoscope
2007;117:1864-70.
- 2. Takano S, Nito T, Tamaruya N, Kimura M,
Tayama N. Single institutional analysis of trends
over 45 years in etiology of vocal fold paralysis.
Auris Nasus Larynx 2012;39:597-600.
- 3. Spataro EA, Grindler DJ, Paniello RC. Etiology
and Time to Presentation of Unilateral Vocal
Fold Paralysis. Otolaryngology–Head and Neck
Surgery 2014;151:286–93.
- 4. Altaş E, Sütbeyaz Y, Öztürk A, Karaşen RM,
Kalkandelen S. Bilateral abduktor kord vokal
paralizi tedavisindeki sorunlar. Türk
Otolarengoloji Arşivi 1998;36:11-4.
- 5. Gürsan Ö, Cantürk MA. Bilateral abduktor
paralizisinin cerrahi tedavisinde Thornell
modifikasyonu ile aritenoidektomi. Türk
Otolarengoloji Arşivi 1990;28:253-5.
- 6. Al-Khtoum N, Shwakfeh N, Al-Safadi E, Al-
Momani O, Hamasha K. Acquired unilateral
vocal fold paralysis: retrospective analysis of a
single institutional experience. N Am J Med Sci
2013;5:699-702.
- 7. Yumoto E, Minoda R, Hyodo M, Yamagata T.
Causes of recurrent laryngeal nerve paralysis.
Auris Nasus Larynx 2002;29:41-5.
- 8. Havas T, Lowinger D, Priestly J. Unilateral
vocal fold paralysis: causes, options and
outcomes. Aust NZ J Surg 1999:69:509-13.
- 9. Glazer HS. Extralaryngeal causes of vocal cord
paralysis: CT evaluation. Am J Radiol
1983;141:527–31.
- 10. Filho JG, Kowalski LP. Surgical complications
after thyroid surgery performed in a cancer
hospital. Otolaryngol Head Neck Surg
2005;132:490-4.
- 11. Francis DO, Pearce EC, Ni S, Garrett CG,
Penson DF. Epidemiology of Vocal Fold
Paralyses after Total Thyroidectomy for Well-
Differentiated Thyroid Cancer in a Medicare
Population. Otolaryngology–Head and Neck
Surgery 2014;150:548-57.
- 12. Bergamaschi R, Becouarn G, Ronceray J,
Arnaud JP. Morbidity of thyroid surgery. Am J
Surg 1998;176:71-5.
- 13. Marti JL, Holm T, Randolph G. Universal use of
intraoperative nerve mon-itoring by recently
fellowship-trained thyroid surgeons is common,
associ-ated with higher surgical volume, and
impacts intraoperativedecision-making. World J
Surg 2016;40:337–343.
- 14. Singer MC, Rosenfeld RM, Sundaram K.
Laryngeal nerve monitoring: cur-rent utilization
among head and neck surgeons. Otolaryngol
Head NeckSurg 2012;146:895-9.
- 15. Chen HC, Jen YM, Wang CH, Lee JC, Lin YS.
Etiology of vocal cord paralysis. ORL J
Otorhinolaryngol Relat Spec 2007;69:167-71.
- 16. Huppler EG, Schmıdt HW, Devıne D, Gage RP.
Causes of vocal-cord paralysis. Proc Staff Meet
Mayo Clin 1955;2;30:518-21.
- 17. Ramadan HH, Wax MK, Avery S. Outcome and
changing cause of unilateral vocal cord
paralysis. Otolaryngol Head Neck Surg
1998;118:199-202.
- 18. Ko HC, Lee LA, Li HY, Fang TJ. Etiologic
features in patients with unilateral vocal fold
paralysis in Taiwan. Chang Gung Med J
2009;32:290-6.
- 19. Taenaka H, Shibata SC, Okitsu K, Iritakenishi T,
Imada T, Akinori Uchiyama A, et al.
Perioperative factors related to the severity of
vocal cord paralysis after thoracic cardiovascular
surgery. Eur J Anaesthesiol 2017;34:425–31.
- 20. Itagaki T, Kikura M, Sato S. Incidence and risk
factors of postoperative vocal cord paralysis in
987 patients after cardiovascular surgery. Ann
Thorac Surg 2007;83:2147-52.