Implications of Synkinesis in Unilateral Vocal Fold Paralysis

Abstract

Objectives

In patients with unilateral vocal fold paralysis (UVFP), laryngeal electromyography (LEMG) occasionally observes synkinesis in laryngeal muscles, a condition that could impair vocal fold mobility and voice control. This study aims to evaluate the impact of synkinesis on UVFP patients.

Study Design

A retrospective case-control study.

Setting

Medical center.

Subjects and Methods

Patients with UVFP onset >6 months were recruited (N = 104). The outcome measurements included LEMG, quantitative LEMG analysis of thyroarytenoid–lateral cricoarytenoid (TA-LCA) muscle complex, glottal gap measured by videolaryngostroboscopy, voice-related quality of life, and voice acoustic analysis.

Results

According to the LEMG analysis, 8 patients (8%) had synkinesis, and 96 (92%) did not. In the synkinesis group, TA-LCA turn frequency in the lesioned side was comparable to that in the healthy side (P = .52). Patients in the synkinesis group had higher TA-LCA turn frequency (P = .001), higher probability of cricothyroid muscle dysfunction (P = .04), and better voice-related quality of life (P = .01) but objective voice outcomes comparable to those in the nonsynkinesis group.

Conclusions

Patients with synkinesis will have near-complete restoration in TA-LCA turn frequency but still experience voice impairment, a finding that is compatible with the mechanism of aberrant reinnervation. However, patients with synkinesis have better disease-related quality of life than do those without synkinesis.

Keywords

synkinesis reinnervation quantitative laryngeal electromyography unilateral vocal fold paralysis voice idiopathic

Get full access to this article

View all access options for this article.

References

Crumley

. Laryngeal synkinesis: its significance to the laryngologist. Ann Otol Rhinol Laryngol. 1989;98:87-92.

Gordon

. Mechanisms for functional recovery of the larynx after surgical repair of injured nerves. J Voice. 1994;8:70-78.

Crumley

McCabe

. Regeneration of the recurrent laryngeal nerve. Otolaryngol Head Neck Surg. 1982;90:442-447.

Blitzer

Jahn

Keidar

. Semon’s law revisited: an electromyographic analysis of laryngeal synkinesis. Ann Otol Rhinol Laryngol. 1996;105:764-769.

Crumley

. Unilateral recurrent laryngeal nerve paralysis. J Voice. 1994;8:79-83.

Crumley

. Laryngeal synkinesis revisited. Ann Otol Rhinol Laryngol. 2000;109:365-371.

Sato

Harvey

Ogura

. Impairment of function of the intrinsic laryngeal muscles after regeneration of the recurrent laryngeal nerve. Laryngoscope. 1974;84:53-66.

Iroto

Hirano

Tomita

. Electromyographic investigation of human vocal cord paralysis. Ann Otol Rhinol Laryngol. 1968;77:296-304.

Farkas

Hamilton-Wright

Parsaei

et al . A review of clinical quantitative electromyography. Crit Rev Biomed Eng. 2010;38:467-485.

10.

Statham

Rosen

Nandedkar

et al . Quantitative laryngeal electromyography: turns and amplitude analysis. Laryngoscope. 2010;120:2036-2041.

11.

Fang

Pei

Hsin

et al . Quantitative laryngeal electromyography assessment of cricothyroid function in patients with unilateral vocal fold paralysis. Laryngoscope. 2015;125:2530-2535.

12.

Maronian

Robinson

Waugh

et al . A new electromyographic definition of laryngeal synkinesis. Ann Otol Rhinol Laryngol. 2004;113:877-886.

13.

Statham

Rosen

Smith

et al . Electromyographic laryngeal synkinesis alters prognosis in vocal fold paralysis. Laryngoscope. 2010;120:285-290.

14.

Pei

Fang

et al . Cricothyroid muscle dysfunction impairs vocal fold vibration in unilateral vocal fold paralysis. Laryngoscope. 2014;124:201-206.

15.

Omori

Kacker

Slavit

et al . Quantitative videostroboscopic measurement of glottal gap and vocal function: an analysis of thyroplasty type I. Ann Otol Rhinol Laryngol. 1996;105:280-285.

16.

Bielamowicz

Stager

. Diagnosis of unilateral recurrent laryngeal nerve paralysis: laryngeal electromyography, subjective rating scales, acoustic and aerodynamic measures. Laryngoscope. 2006;116:359-364.

17.

Lin

Munin

Rosen

et al . Effect of intralaryngeal muscle synkinesis on perception of voice handicap in patients with unilateral vocal fold paralysis. Laryngoscope. 2017;127:1628-1632.

18.

Liguori

Dahl

Fuglsang-Frederiksen

. Turns-amplitude analysis of the electromyographic recruitment pattern disregarding force measurement: I. Method and reference values in healthy subjects. Muscle Nerve. 1992;15:1314-1318.

19.

Liguori

Dahl

Fuglsang-Frederiksen

et al . Turns-amplitude analysis of the electromyographic recruitment pattern disregarding force measurement: II. Findings in patients with neuromuscular disorders. Muscle Nerve. 1992;15:1319-1324.

20.

Pei

Fang

Hsin

et al . Early hyaluronate injection improves quality of life but not neural recovery in unilateral vocal fold paralysis: an open-label randomized controlled study. Restor Neurol Neurosci. 2015;33:121-130.

21.

Fang

Hsin

Chung

et al . Office-based intracordal hyaluronate injections improve quality of life in thoracic-surgery-related unilateral vocal fold paralysis. Medicine (Baltimore). 2015;94:e1787.

22.

Chang

Fang

et al . Quantitative electromyographic characteristics of idiopathic unilateral vocal fold paralysis. Laryngoscope. 2016;126:E362-E368.

23.

Tseng

Pei

Wong

et al . Distinct disease and functional characteristics of thyroid surgery-related vocal fold palsy. Thyroid. 2016;26:943-950.

24.

Pei

Chen

et al . Disease characteristics and electromyographic findings of nonsurgery-related unilateral vocal fold paralysis [published online September 26, 2016]. Laryngoscope.

25.

Gliklich

Glovsky

Montgomery

. Validation of a voice outcome survey for unilateral vocal cord paralysis. Otolaryngol Head Neck Surg. 1999;120:153-158.

26.

Fang

Gliklich

et al . Assessment of Chinese-version voice outcome survey in patients with unilateral vocal cord paralysis. Otolaryngol Head Neck Surg. 2007;136:752-756.

27.

JFR

Tseng

Tsai

. Assessment of health-related quality of life in Taiwan (I): development and psychometric testing of SF-36 Taiwan Version. Tai J Pub Health. 2003;22:501-511.

28.

Tseng

Tsai

. Assessment of health-related quality of life (II): norming and validation of SF-36 Taiwan Version. Tai J Pub Health. 2003;22:512-518.

29.

Hillel

. The study of laryngeal muscle activity in normal human subjects and in patients with laryngeal dystonia using multiple fine-wire electromyography. Laryngoscope. 2001;111:1-47.

30.

Paniello

. Synkinesis following recurrent laryngeal nerve injury: a computer simulation. Laryngoscope. 2016;126:1600-1605.

31.

Gacek

Malmgren

Lyon

. Localization of adductor and abductor motor nerve fibers to the larynx. Ann Otol Rhinol Laryngol. 1977;86:771-776.

32.

Malmgren

Lyon

Gacek

. Localization of abductor and adductor fibers in the kitten recurrent laryngeal nerve: use of a variation of the horseradish peroxidase tracer technique. Exp Neurol. 1977;55:187-198.

33.

Flint

Downs

Coltrera

. Laryngeal synkinesis following reinnervation in the rat: neuroanatomic and physiologic study using retrograde fluorescent tracers and electromyography. Ann Otol Rhinol Laryngol. 1991;100:797-806.