Outcomes in Bilateral Vocal Fold Immobility: A Retrospective Cohort Analysis

Shekhar K. Gadkaree, Alexander Gelbard, Simon R. Best, Lee M. Akst, Martin Brodsky, Alexander T. Hillel

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To test the hypothesis that the etiologies of bilateral vocal fold mobility impairment (BLVFI), bilateral vocal fold paralysis (BVFP), and posterior glottis stenosis (PGS) have distinct clinical outcomes. To identify patient-specific and procedural factors that influence tracheostomy-free survival. Study Design: Retrospective cohort study. Setting: Johns Hopkins Medical Center from 2004 to 2015. Subjects and Methods: Case series with chart review of 68 patients with PGS and 17 patients with BVFP. Multiple logistic regression analysis determined factors associated with airway prosthesis dependence at last follow-up and the procedural burden (defined as number of operative procedures per year). Results: PGS comprised the majority of BLVFI (76%). PGS injury arose primarily after endotracheal intubation (91%), while BVFP most commonly was due to iatrogenic surgical injury to bilateral recurrent laryngeal nerves (88%, P <.001). Overall in BLVFI, 66% were tracheostomy free at last follow-up (62% in PGS, 82% in BVFP). Of those who underwent an operative intervention to be decannulated, 88% were decannulated (90% PGS, 80% BVFP). Patients with PGS required higher procedural burden to achieve decannulation compared with the BVFP cohort (3.1 ± 5.2 vs 0.71 ± 1.4, P =.002). In multivariate analysis of PGS, smoking was a risk factor for tracheostomy dependence (P =.026). Conclusions: BLVFI is primarily an iatrogenic complication. There are high rates of tracheostomy dependence in BLVFI, with procedural intervention needed for decannulation. Compared with BVFP, patients with PGS had a higher procedural burden overall and to achieve decannulation. Patients with PGS should be counseled that smoking, a modifiable risk factor, may increase the risk of tracheostomy dependence.

Original languageEnglish (US)
Pages (from-to)1020-1027
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume159
Issue number6
DOIs
StatePublished - Dec 1 2018

Keywords

  • bilateral vocal fold immobility
  • bilateral vocal fold paralysis
  • glottic stenosis
  • outcomes in bilateral vocal fold immobility
  • posterior glottic stenosis
  • vocal fold immobility

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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