| Abstract [eng] |
Bilateral vocal cord paralysis is a rare pathology characterised by bilateral vocal cord immobility. Bilateral vocal cord paralysis is approximately 4 times less common than unilateral vocal cord paralysis. The clinic may present with respiratory disturbances and voice changes. The main cause of the pathology is damage to the n.laryngeus reccurens after surgical treatment, most commonly after thyroidectomies and other operations on the neck and chest area. Tumours, intubation trauma and neurogenic disorders are less frequent aetiologies. Idiopathic cases of bilateral vocal cord paralysis are the rarest. Flexible fibreoptic laryngoscopy is considered the gold standard for the diagnosis of bilateral vocal cord paralysis. In the case of an oncological aetiology, computed tomography and magnetic resonance imaging allow the exact location of the origin of the pathology. Laryngeal electroneurouromiography is useful in differential diagnosis and in predicting poor prognosis. Bilateral vocal cord lesions manifested only by changes in voice quality or asymptomatically are treated conservatively with voice therapy and treatment of concomitant diseases. Surgical treatment is indicated for dyspnoea and marked stridor. Reversible procedures include tracheostomies, botulinum toxin injections, laterofixation, and irreversible procedures include endoscopic laryngeal surgery to widen the vocal cleft. Reversible surgeries preserve the physiological structure of the larynx and have a short-term effect, with a better prognosis for recovery in patients, while irreversible surgeries may cause irreversible changes to the larynx and may require repeated operations. The outcomes of arytenoidectomy and cordotomy are similar, but cordotomy is associated with better voice quality outcomes and a lower risk of postoperative aspiration. A newer endoscopic treatment method, posterior glottoplasty, has a more difficult technique, but preserves vocal fold phonatory function better than arytenoidectomy and cordotomy. Reinnervation is a technically demanding procedure, but promising because it does not damage the structure of the larynx. Laryngeal stimulator - also a promising treatment method, but more expensive than the others and requiring battery replacement. Stem cell and gene therapies remain experimental treatments as there are still no human trials. |
