Stimmlippenparesen – Untersuchungen an einem Kollektiv von 400 Patienten

Zusammenfassung

Die Ursachen für Stimmlippenparesen sind vielfältig, wobei in der vorliegenden Untersuchung die postchirurgisch/traumatischen mit gut zwei Dritteln der Fälle am häufigsten anzutreffen waren, gefolgt von den primär tumorbedingten Paresen. Bei den beidseitigen Paresen war ein Schilddrüseneingriff die häufigste Ursache, vor allem, wenn es sich um eine Thyreoidektomie aufgrund eines Malignoms oder eines Rezidivschilddrüseneingriffs handelte. Therapeutisch war eine Stimmtherapie bei Patienten mit einer einseitigen Parese und dem Hauptsymptom Heiserkeit erfolgsversprechend. Nur in etwa 6% ergab sich bei Glottisschlussinsuffizienz die Notwendigkeit eines operativen Glottis verengenden Eingriffs. Aufgrund von Dyspnoe, dem Kernsymptom bei einer beidseitigen Stimmlippenparese, musste bei knapp der Hälfte der Patienten eine temporäre Tracheotomie bzw. ein Glottis erweiternder Eingriff vorgenommen werden. Die Gruppe der idiopathischen und traumatischen Paresen zeigten innerhalb der ersten 12 Monate die vergleichsweise beste Erholungstendenz, wohingegen es bei den primär tumorbedingten erwartungsgemäß zu keiner Funktionsrückkehr des geschädigten Rekurrensnerven kam.

Abstract

Vocal Cord Paralysis – Analysis of a Cohort of 400 Patients

Vocal cord paralysis has diverse etiologies. In the present study, vocal chord paralysis caused by surgery/trauma was present in more than two thirds of the cases, followed by primary malignancy-associated paralysis. Thyroidectomy was the most common cause in bilateral paresis, especially if performed in recurrent or malignant disease. Voice therapy was promising in pa­tients with unilateral paresis and hoarseness as main symptom. Persistent dysphonia due to insufficiency of the glottic closure led to an operative glottis restricting procedure in only 6% of cases. In almost half the patients with dyspnea as the main symp­tom of bilateral vocal cord paresis, temporary tracheotomy or surgical glottis widening procedures had to be performed. The group of idiopathic and traumatic paresis patients showed the best spontaneous recovery within the first 12 months in comparison to primary malignancy-associated paralysis, which showed no recovery of the recurrens nerve.

Schlüsselwörter

Stimmlippe - Parese - Ätiologie - Struma - idiopathisch

Key words

vocal cord - paresis - etiology - goitre - idiopathic

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