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Vocal fold insufficiency

When vocal cords cannot close completely, it is called vocal cord dysfunction, glottic insufficiency, or vocal fold insufficiency. Vocal fold insufficiency may be overlooked in a preliminary clinical evaluation1 in a patient with early or subtle vocal fold weakness where both vocal folds may appear mobile.

Vocal fold insufficiency is a common contributing factor in patients who present with dysphonia.1 A thorough exam, including visualization of the larynx, is essential to diagnose dysphonia caused by vocal fold insufficiency, especially in early stages.

Specific types of vocal fold insufficiency include1,2:

  • Paralysis of one or both* vocal folds due to:
    • Nerve injury
      • Iatrogenic—injury from intubation during surgery or surgical procedures themselves, such as thyroidectomy or cervical disc surgery
      • Trauma
    • Disease such as:
      • Tumors
      • Neurologic disorders such as Parkinson's disease—in fact, more than 70% of patients with Parkinson's disease experience dysphonia characterized by weak and breathy phonation and dysarthria3
  • Paresis (partial paralysis) of one or both* vocal folds
  • Vocal fold atrophy due to age, disease, or medications

*PROLARN GEL and PROLARYN PLUS are not indicated for paralysis of both vocal folds.

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References
  1. Rosen CA, Simpson CB. Glottic insufficiency: Vocal fold paralysis, paresis, and atrophy. In: Operative Techniques in Laryngology. Heidelberg, Germany: Springer-Verlag; 2008.
  2. Giraldez-Rodriguez LA, Johns M. Glottal insufficiency with aspiration risk in dysphagia. Otolaryngol Head Neck Surg. 2013;46:1113-1121.
  3. Berke GS, Gerratt B, Kreiman J, Jackson K. Treatment of Parkinson hypophonia with percutaneous collagen augmentation. Laryngoscope. 1999;109:1295-1299.
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