Arytenoid appearance and vertical level difference between the paralyzed and innervated vocal cords

Area of Science:

• Laryngology
• Vocal fold paralysis
• Voice disorders

Background:

• Unilateral vocal fold paralysis often results in the affected fold resting higher than the healthy one.
• This study investigates the relationship between arytenoid appearance and vocal fold height differences.

Purpose of the Study:

• To correlate arytenoid visualization with the vertical level differences between paralyzed and normally innervated vocal folds.
• To challenge the conventional understanding of paralyzed vocal fold positioning.

Main Methods:

• Retrospective analysis of video recordings from 38 patients with unilateral vocal fold paralysis.
• Assessment of vocal fold and arytenoid positions during phonation and inspiration.
• Categorization of arytenoid appearances based on visualized medial surface portions.

Main Results:

• Medial vocal fold paralysis often showed no significant height difference compared to the normally innervated fold during phonation.
• Arytenoid appearance influenced vocal fold height in medial paralysis, with some cases appearing lower or higher.
• In lateral paralysis, most affected vocal folds did not rest higher than the contralateral fold during phonation.

Conclusions:

• Paralyzed vocal fold height is not consistently higher than the normally innervated fold.
• Vocal fold positioning is variable and depends on paralysis type, laryngeal status, and arytenoid morphology.
• The assumption of a higher resting position for paralyzed vocal folds requires re-evaluation.