[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.197.171.35. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Download PDF
Table 1. 
Etiology of Vocal Cord Palsy (VCP)
Etiology of Vocal Cord Palsy (VCP)
Table 2. 
Central Nervous System (CNS) Conditions Found in Association With Idiopathic Vocal Cord Palsies in a Series of 35 Patients
Central Nervous System (CNS) Conditions Found in Association With Idiopathic Vocal Cord Palsies in a Series of 35 Patients
Table 3. 
Number of Underlying Neurological Conditions in Patients Diagnosed With Vocal Cord Palsy (VCP)
Number of Underlying Neurological Conditions in Patients Diagnosed With Vocal Cord Palsy (VCP)
1.
Laccourreye  OPapon  JFKania  RMenard  MBrasnu  DHans  S Unilateral laryngeal paralyses: epidemiological data and therapeutic progress. Presse Med 2003;32781- 786
PubMed
2.
Jorgensen  GClausen  EWMantoni  MYMisciattelli  LBalle  V Etiology and diagnostic methods in vocal cord paralysis. Ugeskr Laeger 2003;165690- 694
PubMed
3.
McEntagart  MSpurlock  GJackson  CHarper  PRahman  N Distal spinal muscular atrophy with vocal cord paralysis (dSMA-VII) is not linked to the MPD2 locus on chromosome 5q31. J Med Genet 2000;37E14
PubMedArticle
4.
McEntagart  MNorton  NWilliams  H  et al.  Localization of the gene for distal hereditary motor neuronopathy VII (dHMN-VII) to chromosome 2q14. Am J Hum Genet 2001;681270- 1276
PubMedArticle
5.
Higo  RTayama  NWatanabe  TNitou  TTakeuchi  S Vocal fold motion impairment in patients with multiple system atrophy: evaluation of its relationship with swallowing function. J Neurol Neurosurg Psychiatry 2003;74982- 984
PubMedArticle
6.
Ludlow  CL Recent advances in laryngeal sensorimotor control for voice, speech and swallowing. Curr Opin Otolaryngol Head Neck Surg 2004;12160- 165
PubMedArticle
7.
Daya  HHosni  ABejar-Solar  IEvans  JNBailey  CM Pediatric vocal cord paralysis: a long-term retrospective study. Arch Otolaryngol Head Neck Surg 2000;12621- 25
PubMedArticle
8.
de Gaudemar  IRoudaire  MFrancois  MNarcy  P Outcome of laryngeal paralysis in neonates: a long term retrospective study of 113 cases. Int J Pediatr Otorhinolaryngol 1996;34101- 110
PubMedArticle
9.
Gupta  AKMann  SBNagarkar  N Surgical management of bilateral immobile vocal folds and long-term follow-up. J Laryngol Otol 1997;111474- 477
PubMed
10.
Havas  TLowinger  DPriestly  J Unilateral vocal fold paralysis: causes, options and outcomes. Aust N Z J Surg 1999;69509- 513
PubMedArticle
11.
Ramadan  HHWax  MKAvery  S Outcome and changing cause of unilateral vocal cord paralysis. Otolaryngol Head Neck Surg 1998;118199- 202
PubMedArticle
12.
Srirompotong  SSae-Seow  PSrirompotong  S The cause and evaluation of unilateral vocal cord paralysis. J Med Assoc Thai 2001;84855- 858
PubMed
13.
Peters  M Cerebral asymmetry for speech and the asymmetry in path lengths for the right and left recurrent nerves. Brain Lang 1992;43349- 352
PubMedArticle
14.
Katz  ADNemiroff  P Anastamoses and bifurcations of the recurrent laryngeal nerve: report of 1177 nerves visualized. Am Surg 1993;59188- 191
PubMed
15.
Dedo  HHBehlau  MS Recurrent laryngeal nerve section for spastic dysphonia: 5- to 14-year preliminary results in the first 300 patients. Ann Otol Rhinol Laryngol 1991;100274- 279
PubMed
16.
Isozaki  EHayashi  MHayashida  TOda  MHirai  S Myopathology of the intrinsic laryngeal muscles in neurodegenerative diseases, with reference to the mechanism of vocal cord paralysis. Rinsho Shinkeigaku 1998;38711- 718
PubMed
17.
Isozaki  ENaito  RKanda  TMizutani  THirai  S Different mechanism of vocal cord paralysis between spinocerebellar ataxia (SCA 1 and SCA 3) and multiple system atrophy. J Neurol Sci 2002;19737- 43
PubMedArticle
18.
Sellars  CCampbell  AMStott  DJStewart  MWilson  JA Swallowing abnormalities after acute stroke: a case control study. Dysphagia 1999;14212- 218
PubMedArticle
19.
 Multiple sclerosis (MS). Aetna InteliHealth Web site.  Available at: http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/34955.html. Accessed September 2, 2004
20.
Cordes  S Neurological disorders of the larynx and videostroboscopy: University of Texas Medical Branch (UTMB) Grand Rounds Presentation. UTMB Web site.  April 8, 1998. Available at: http://www.utmb.edu/otoref/Grnds/Neuro-larynx-9804/Neuro-larynx-9804.html. Accessed September 8, 2004
21.
 Parkinson’s disease (PD). Aetna InteliHealth Web site.  Available at: http://www.intelihealth.com/IH/ihtIH?d=dmtHealthAZ&c=201957&p=~br,IHW|~st,9339|~r,WSIHW000|~b,*|. Accessed September 8, 2004
22.
Howard  JF Myasthenia gravis: a summary.  Myasthenia Gravis Foundation of America and James F. Howard, Jr; 1997. Available at: http://www.myasthenia.org/information/summary.htm. Accessed September 2, 2004
23.
Teramoto  KKuwabara  MMatsubara  Y Respiratory failure due to vocal cord paresis in myasthenia gravis. Respiration 2002;69280- 282
PubMedArticle
24.
 Guillain-Barré syndrome. Mayo Clinic Web site.  Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00413&section=1. Accessed September 2, 2004
25.
Hughes  RGGibbin  KPLowe  J Vocal fold abductor paralysis as a solitary and fatal manifestation of multiple system atrophy. J Laryngol Otol 1998;112177- 178
PubMed
26.
Robinson  LRHillel  ADWaugh  PF New laryngeal muscle weakness in post-polio syndrome. Laryngoscope 1998;108732- 734
PubMedArticle
27.
Yokoji  INakamura  SIkeda  T A case of progressive supranuclear palsy associated with bilateral vocal cord abductor paralysis. Rinsho Shinkeigaku 1997;37523- 525
PubMed
28.
 NINDS Progressive Supranuclear Palsy Information Page. National Institute of Neurological Disorders and Stroke, National Institutes of Health, Web site.  Available at: http://www.ninds.nih.gov/health_and_medical/disorders/psp.htm. Accessed September 2, 2004
29.
Hahn  JSHenry  MHudgins  LMadan  A Congenital hypomyelination neuropathy in a newborn infant: unusual case of diaphragmatic and vocal cord paralyses. Pediatrics 2001;108E95
PubMedArticle
30.
 NINDS Wallenberg’s Syndrome Information Page. National Institute of Neurological Disorders and Stroke, National Institutes of Health, Web site.  Available at: http://ninds.nih.gov/health_and_medical/disorders/wallenbergs.htm. Accessed September 2, 2004
31.
Sulica  LBlitzer  ALovelace  REKaufmann  P Vocal fold paresis of Charcot-Marie-Tooth disease. Ann Otol Rhinol Laryngol 2001;1101072- 1076
PubMed
32.
Santoro  LManganelli  FDi Maio  L  et al.  Charcot-Marie-Tooth disease type 2C: a distinct genetic entity: clinical and molecular characterization of the first European family. Neuromuscul Disord 2002;12399- 404
PubMedArticle
33.
Marchant  HSupiot  FChoufani  GHassid  S Bilateral vocal fold palsy caused by chronic motor axonal neuropathy. J Laryngol Otol 2003;117414- 416
PubMedArticle
34.
Dray  TRobinson  LHillel  A Idiopathic bilateral vocal fold weakness. Laryngoscope 1999;109995- 1002
PubMedArticle
Original Article
December 2005

Idiopathic Vocal Cord Palsies and Associated Neurological Conditions

Author Affiliations

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Dr Urquhart) and Neurology (Dr St. Louis), Marshfield Clinic, Marshfield, Wis. Dr St. Louis is now with the Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City.

Arch Otolaryngol Head Neck Surg. 2005;131(12):1086-1089. doi:10.1001/archotol.131.12.1086
Abstract

Objective  To retrospectively review the clinical case records of patients with idiopathic vocal cord palsies (VCPs) for the presence of preexisting or subsequent development of neurological disease, including multiple sclerosis, motor neuron disease, myasthenia gravis, cerebrovascular disease, and Guillain-Barré syndrome.

Design  Retrospective case review of all patients with VCP presenting sequentially within a 45-month time span.

Setting  Tertiary referral center.

Patients  One hundred ninety-three patients with VCP.

Results  Thirty-five cases of VCP (18.1%) were idiopathic. Eight (22.8%) resolved after a mean time of 5 months. A preexisting central nervous system condition was noted in 9 (25.7%) of 35 patients with idiopathic VCP. A subsequent central nervous system condition developed in 7 patients (20.0%). These included 2 cases of cerebrovascular accidents, 1 case of postpolio syndrome with respiratory failure, and 1 case of polyneuropathy secondary to paraneoplastic syndrome.

Conclusions  A high frequency of neurological conditions was observed in adult patients initially presenting with idiopathic VCP. Patients with VCP but without overt neurological disease may also subsequently develop a serious neurological condition. Careful neurological evaluation of all patients with idiopathic VCP is recommended.

Adult unilateral vocal cord palsy (VCP) is a relatively common voice disorder characterized by a malfunction of the laryngeal muscles. A number of well known disorders, diseases, and surgical sequelae can cause VCP. However, causes remain idiopathic in approximately 12% of cases.1,2 Familial VCP exhibits a constellation of polyneuropathies,3,4 and vocal fold motion impairment is one component of multiple system atrophy.5,6 This suggests that some cases of idiopathic VCP may involve concomitant disseminated neuronal degenerative processes.

The objective of this study was to determine whether the patients with idiopathic unilateral VCP treated at our otolaryngology specialty clinic might have preexisting or subsequently developed neurological conditions.

METHODS

We performed a retrospective review of all patients with VCPs seen at the Department of Otolaryngology–Head and Neck Surgery at the Marshfield Clinic, Marshfield, Wis, from January 1996 to October 1999. The clinical records of all patients with idiopathic VCP were reviewed for preexisting, or the subsequent development of, neurological disease. All patients with neurological conditions, including multiple sclerosis, motor neuron disease, and Guillain-Barré syndrome, were examined and evaluated by a neurologist. Additional workup depended on the patient’s condition and the decision of the neurologist. All patients were evaluated by an otolaryngologist and received a complete head and neck examination. The diagnosis of idiopathic VCP was made after a complete workup, including a computed tomographic scan of the neck and chest visualizing the path of the vagus and recurrent laryngeal nerves. Findings from blood tests performed for most patients included a complete blood cell count; measures of erythrocyte sedimentation rate, thyroid stimulating hormone, and glucose level; Lyme disease titers; venereal disease research laboratory slide test; and fluorescent treponemal antibody test. Laryngeal electromyography was used when indicated in deciding the appropriate time to perform surgery for rehabilitation of the VCP.

RESULTS

One hundred ninety-three patients were diagnosed with VCPs over a 45-month period (January 1996 to October 1999). Sixty-nine (35.8%) of the diagnoses were related to intubation and/or surgery (the most common cause). Thyroid and thoracic/cardiac surgical procedures were nearly equal causes of VCP (n = 33). Forty-six cases (23.8%) were due to tumors, 19 (9.8%) to trauma, 17 (8.8%) to cerebrovascular disease, and 7 (3.6%) to congenital and inflammatory conditions. Thirty-five cases (18.1%) were idiopathic (Table 1).

There were nearly equal numbers of men (n = 18) and women (n = 17) with idiopathic VCP. Mean age was 63.5 years (age range, 22-87 years). The mean follow-up period was 23¼ months (range, 0-116 months). All cases were unilateral. More than twice as many cases of idiopathic VCP were found on the left side as on the right side (24 vs 11). A preexisting central nervous system condition was noted in 9 (25.7%) of 35 patients. A subsequent central nervous system condition developed in 7 patients (20.0%) with a mean time to diagnosis of 17 months (range, 2 weeks to 4 years). Preexisting and subsequently developed central nervous system conditions identified are listed in (Table 2). Eight cases (22.8%) of idiopathic VCP resolved in a mean time of 5 months (range, 23 days to 26 months).

COMMENT

In this series of adult patients, nearly half of the patients with idiopathic unilateral VCP presented with, or were subsequently diagnosed as having, neurological conditions. Our study confirms and extends evidence for such an association ((Table 3).

Several retrospective reviews7,8 have suggested an association in children between idiopathic VCP and underlying neurological conditions. In a consecutive sample of 102 cases of pediatric VCP, 35% were classified as idiopathic and 16% as having underlying neurologic conditions.7 Seven patients had Arnold Chiari malformation, 2 exhibited peripheral neurological disease, 1 had hereditary distal spinal muscular degeneration, and 1 had Horner syndrome ipsilateral to the VCP. Of 113 children diagnosed with congenital VCP, excluding postsurgical cases, 37% had idiopathic VCP, and 25% had associated neonatal neurological diseases.8

In adults, the rate of idiopathic VCP is similarly high and is sometimes associated with a neurological condition (Table 3). In a series of 61 adult patients with bilateral VCP, 39% of cases were idiopathic.9 However, in that series, despite detailed ear, nose, and throat, neurological, and radiological examinations, no underlying neurological disorders were disclosed. Havas et al10 classified etiologies of unilateral VCP in 108 patients. Forty-five cases were iatrogenic, and 36 cases were idiopathic. Of the remaining 27 patients, 6 had a central nervous system disorder or systemic neurological disorder, 3 had vagus neuroma or neurofibroma, and 2 had postpolio syndrome. Ramadan et al11 evaluated 98 patients with unilateral VCP. The cause was found to be neoplastic disease in 32% of the cases; idiopathic in 16%); or caused by surgery (30%), trauma (11%), central nervous system disorder (8%; all 8 cases were the result of stroke), or infection (3%). Associated cranial nerve injuries were found in 9 patients. Five patients had injuries to cranial nerve 11, and 4 patients, to cranial nerve 12. Srirompotong et al12 evaluated 90 patients with unilateral VCP, finding that 29% of cases were due to neoplasm; 21%, inflammation; 8%, trauma from endotracheal intubation and external laryngeal trauma; and 5%, central nervous system disease. Twenty-four percent were iatrogenic, and 13% were idiopathic.

PATHOPHYSIOLOGIC CONSIDERATIONS

In our series of patients with unilateral VCP, it is difficult to make a pathophysiological connection between idiopathic VCP and some diagnoses (eg, dementia or presyncope) (Table 2). How and why should a patient with multiple cranial neuropathies or postpolio syndrome be prone to develop VCP? There are isolated forms of idiopathic Guillain-Barré–type illnesses, inflammatory or infiltrative neoplastic skull base diseases, and a variety of other similar disorders that could logically affect both cranial nerves and their various branches. The neurological conditions that preceded VCP (in 5 of 9 cases) seem to be associated with either the brainstem outflow end of the neuraxis or the segmental laryngeal or esophageal anatomy (the neuromuscular disorders, multiple cranial neuropathies, esophageal dysmotility, and laryngeal spasms).

Similarly, it is unclear whether VCP potentially heralds any subsequent neurological diagnosis. The subsequent neurological conditions included hearing loss or vertigo and postpolio neuropathies. These conditions seem to suggest an association of idiopathic VCP with neuromuscular disorders because 9 (26%) of 35 patients have either a neuromuscular or closely aligned otolaryngologic diagnosis before or after VCP is diagnosed.

The left vocal cord is more vulnerable to injury than the right, as noted herein. The left recurrent laryngeal nerve is longer. Typically, there is a 28% difference in length; it can vary from 5 to 15 cm.13 In addition, there is pronounced variation in the way in which the 2 recurrent laryngeal nerves meet the larynx.14 In a now-discontinued procedure for the treatment of spasmodic dysphonia, the left recurrent laryngeal nerve was chosen for sectioning more often than the right because the right has a lower risk of subsequent disease.15 Whether such anatomical differences and susceptibility to disease are evidenced by the 2-fold increased incidence of left-sided VCP in our study remains to be proved.

CENTRAL NERVOUS SYSTEM DISORDERS VS PERIPHERAL NEUROLOGICAL ETIOLOGIES

The neurological disorders reported to be associated with VCP seem to be divisible into central nervous system disorders (cerebrovascular disease, multiple sclerosis, multiple system atrophy, Parkinson disease, progressive supranuclear palsy, and Arnold-Chiari malformation) and peripheral nervous system disorders (eg, Wallenberg syndrome, myasthenia gravis, Guillain-Barré syndrome, postpolio syndrome, congenital hypomyelination neuropathy, Charcot-Marie-Tooth disease, and chronic motor axonal neuropathy).7,8,1633 Although cases of idiopathic VCP can occasionally be bilateral, they are usually unilateral. Our series of patients were all adults with unilateral VCP, and nearly half (46%) either had preexisting or subsequently developed comorbid neurological conditions.

Our study validates findings that cerebrovascular disease is a common cause of VCP. Seventeen (9%) of the 69 cases reviewed were caused by stroke. Two patients previously diagnosed as having idiopathic VCP, 1 of whom had a history of transient ischemic attacks, subsequently experienced cerebrovascular accidents.18

Two of our 35 patients with idiopathic VCP, 1 of whom subsequently developed respiratory failure, were diagnosed as having postpolio syndrome. Common signs and symptoms include breathing or swallowing problems and sleep-related breathing disorders. Postpolio laryngeal muscle weakness requiring surgical intervention is reported.26

LIMITATIONS

In our case series, we were unable to perform extensive medical chart abstractions on an age-matched control group that would enable us to determine rates of the identified neurological conditions in our general population for comparison with the rates seen among our patients with VCP. In addition, the mean time elapsed from diagnosis of VCP to a subsequent neurologic condition in our patients was 17 months (range, 2 weeks to 4 years). Likewise, the time between the diagnosis of a preexisting neurological condition and the subsequent evolution of VCP was not determined. Therefore, any cause-and-effect relationships between neurological conditions and idiopathic VCP cannot be established in our study. Rather, our findings suggest a need for a further prospective cohort study of patients with idiopathic VCP with comparison to an age-matched, population-based control group to ascertain whether a valid epidemiological and temporal association exists between idiopathic VCP and neurological disorders.

In conclusion, the number of patients diagnosed with VCP is rising as physicians become more aware of its prevalence.20,34 Given the frequency of associated neurological conditions in adult patients with idiopathic VCP, a careful neurological examination should be considered for all patients. A prospective study focusing on serial neurological evaluation in patients with idiopathic VCP should be mounted.

Back to top
Article Information

Correspondence: Andrew C. Urquhart, MD, Department of Otolaryngology–Head and Neck Surgery, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449 (urquhart.andrew@marshfieldclinic.org).

Accepted for Publication: March 22, 2004; final revision received July 14, 2005; accepted July 28, 2005.

Financial Disclosure: None.

Acknowledgment: We thank the Marshfield Clinic Research Foundation for providing assistance in the preparation of this manuscript through the services of Doreen Luepke, Anne Nikolai, Graig Eldred, PhD, Linda Weis, and Alice Stargardt.

References
1.
Laccourreye  OPapon  JFKania  RMenard  MBrasnu  DHans  S Unilateral laryngeal paralyses: epidemiological data and therapeutic progress. Presse Med 2003;32781- 786
PubMed
2.
Jorgensen  GClausen  EWMantoni  MYMisciattelli  LBalle  V Etiology and diagnostic methods in vocal cord paralysis. Ugeskr Laeger 2003;165690- 694
PubMed
3.
McEntagart  MSpurlock  GJackson  CHarper  PRahman  N Distal spinal muscular atrophy with vocal cord paralysis (dSMA-VII) is not linked to the MPD2 locus on chromosome 5q31. J Med Genet 2000;37E14
PubMedArticle
4.
McEntagart  MNorton  NWilliams  H  et al.  Localization of the gene for distal hereditary motor neuronopathy VII (dHMN-VII) to chromosome 2q14. Am J Hum Genet 2001;681270- 1276
PubMedArticle
5.
Higo  RTayama  NWatanabe  TNitou  TTakeuchi  S Vocal fold motion impairment in patients with multiple system atrophy: evaluation of its relationship with swallowing function. J Neurol Neurosurg Psychiatry 2003;74982- 984
PubMedArticle
6.
Ludlow  CL Recent advances in laryngeal sensorimotor control for voice, speech and swallowing. Curr Opin Otolaryngol Head Neck Surg 2004;12160- 165
PubMedArticle
7.
Daya  HHosni  ABejar-Solar  IEvans  JNBailey  CM Pediatric vocal cord paralysis: a long-term retrospective study. Arch Otolaryngol Head Neck Surg 2000;12621- 25
PubMedArticle
8.
de Gaudemar  IRoudaire  MFrancois  MNarcy  P Outcome of laryngeal paralysis in neonates: a long term retrospective study of 113 cases. Int J Pediatr Otorhinolaryngol 1996;34101- 110
PubMedArticle
9.
Gupta  AKMann  SBNagarkar  N Surgical management of bilateral immobile vocal folds and long-term follow-up. J Laryngol Otol 1997;111474- 477
PubMed
10.
Havas  TLowinger  DPriestly  J Unilateral vocal fold paralysis: causes, options and outcomes. Aust N Z J Surg 1999;69509- 513
PubMedArticle
11.
Ramadan  HHWax  MKAvery  S Outcome and changing cause of unilateral vocal cord paralysis. Otolaryngol Head Neck Surg 1998;118199- 202
PubMedArticle
12.
Srirompotong  SSae-Seow  PSrirompotong  S The cause and evaluation of unilateral vocal cord paralysis. J Med Assoc Thai 2001;84855- 858
PubMed
13.
Peters  M Cerebral asymmetry for speech and the asymmetry in path lengths for the right and left recurrent nerves. Brain Lang 1992;43349- 352
PubMedArticle
14.
Katz  ADNemiroff  P Anastamoses and bifurcations of the recurrent laryngeal nerve: report of 1177 nerves visualized. Am Surg 1993;59188- 191
PubMed
15.
Dedo  HHBehlau  MS Recurrent laryngeal nerve section for spastic dysphonia: 5- to 14-year preliminary results in the first 300 patients. Ann Otol Rhinol Laryngol 1991;100274- 279
PubMed
16.
Isozaki  EHayashi  MHayashida  TOda  MHirai  S Myopathology of the intrinsic laryngeal muscles in neurodegenerative diseases, with reference to the mechanism of vocal cord paralysis. Rinsho Shinkeigaku 1998;38711- 718
PubMed
17.
Isozaki  ENaito  RKanda  TMizutani  THirai  S Different mechanism of vocal cord paralysis between spinocerebellar ataxia (SCA 1 and SCA 3) and multiple system atrophy. J Neurol Sci 2002;19737- 43
PubMedArticle
18.
Sellars  CCampbell  AMStott  DJStewart  MWilson  JA Swallowing abnormalities after acute stroke: a case control study. Dysphagia 1999;14212- 218
PubMedArticle
19.
 Multiple sclerosis (MS). Aetna InteliHealth Web site.  Available at: http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/34955.html. Accessed September 2, 2004
20.
Cordes  S Neurological disorders of the larynx and videostroboscopy: University of Texas Medical Branch (UTMB) Grand Rounds Presentation. UTMB Web site.  April 8, 1998. Available at: http://www.utmb.edu/otoref/Grnds/Neuro-larynx-9804/Neuro-larynx-9804.html. Accessed September 8, 2004
21.
 Parkinson’s disease (PD). Aetna InteliHealth Web site.  Available at: http://www.intelihealth.com/IH/ihtIH?d=dmtHealthAZ&c=201957&p=~br,IHW|~st,9339|~r,WSIHW000|~b,*|. Accessed September 8, 2004
22.
Howard  JF Myasthenia gravis: a summary.  Myasthenia Gravis Foundation of America and James F. Howard, Jr; 1997. Available at: http://www.myasthenia.org/information/summary.htm. Accessed September 2, 2004
23.
Teramoto  KKuwabara  MMatsubara  Y Respiratory failure due to vocal cord paresis in myasthenia gravis. Respiration 2002;69280- 282
PubMedArticle
24.
 Guillain-Barré syndrome. Mayo Clinic Web site.  Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00413&section=1. Accessed September 2, 2004
25.
Hughes  RGGibbin  KPLowe  J Vocal fold abductor paralysis as a solitary and fatal manifestation of multiple system atrophy. J Laryngol Otol 1998;112177- 178
PubMed
26.
Robinson  LRHillel  ADWaugh  PF New laryngeal muscle weakness in post-polio syndrome. Laryngoscope 1998;108732- 734
PubMedArticle
27.
Yokoji  INakamura  SIkeda  T A case of progressive supranuclear palsy associated with bilateral vocal cord abductor paralysis. Rinsho Shinkeigaku 1997;37523- 525
PubMed
28.
 NINDS Progressive Supranuclear Palsy Information Page. National Institute of Neurological Disorders and Stroke, National Institutes of Health, Web site.  Available at: http://www.ninds.nih.gov/health_and_medical/disorders/psp.htm. Accessed September 2, 2004
29.
Hahn  JSHenry  MHudgins  LMadan  A Congenital hypomyelination neuropathy in a newborn infant: unusual case of diaphragmatic and vocal cord paralyses. Pediatrics 2001;108E95
PubMedArticle
30.
 NINDS Wallenberg’s Syndrome Information Page. National Institute of Neurological Disorders and Stroke, National Institutes of Health, Web site.  Available at: http://ninds.nih.gov/health_and_medical/disorders/wallenbergs.htm. Accessed September 2, 2004
31.
Sulica  LBlitzer  ALovelace  REKaufmann  P Vocal fold paresis of Charcot-Marie-Tooth disease. Ann Otol Rhinol Laryngol 2001;1101072- 1076
PubMed
32.
Santoro  LManganelli  FDi Maio  L  et al.  Charcot-Marie-Tooth disease type 2C: a distinct genetic entity: clinical and molecular characterization of the first European family. Neuromuscul Disord 2002;12399- 404
PubMedArticle
33.
Marchant  HSupiot  FChoufani  GHassid  S Bilateral vocal fold palsy caused by chronic motor axonal neuropathy. J Laryngol Otol 2003;117414- 416
PubMedArticle
34.
Dray  TRobinson  LHillel  A Idiopathic bilateral vocal fold weakness. Laryngoscope 1999;109995- 1002
PubMedArticle
×