Significance of unilateral vocal cord paralysis diagnosed during bronchoscopy

ABSTRACT

Morphology and movements of vocal cords should be checked during bronchoscopy. In past literature, unilateral vocal paralysis is considered as benign. Evaluation of major underlying disease in patients with unilateral vocal cord paralysis diagnosed during bronchoscopy. A cross sectional case control study design was used to evaluate all patients who underwent bronchoscopy during the year 2003 for various causes. Sample size was 194 patients [0.01 error and 80% potency]. Data including patient's respiratory complaints and radiological findings were gathered in a questionnaire. Bronchoscopy was performed in standard condition using local anesthesia. During procedure, vocal cord movement was examined with appropriate maneuver, and complete study of trachobronchial tree with bronchial lavage was done. Appropriate biopsy was performed when indicated. Specimens were sent for evaluation of AFB, cytology, histopathology and culture for mycobacterium tuberculosis. Unilateral vocal cord paralysis was observed in 10% [19 of total 189 patients who underwent bronchoscopy], Male to female ratio was 32 and average age of patients was 65 years [range= 37-76]. Cough was the main complaint in 94%, dyspnea in 100% and hemoptysis in 32%. Smoking was present in 9 patients [47%]. Vocal cord paralysis in left side was predominant and it was seen in 68% [13/19]. Twelve patients [63%] with unilateral vocal cord paralysis had significant lung disease, eight had pulmonary tuberculosis, and four had lung cancer [one SCC, one SmCC, and two undifferentiated carcinoma]. Confirmed lung disorders in case group was significantly more than control group [chi square=4.92; p=0.026; Odd ratio= 2.93, 95% Cl=1.01-8.76]]. In the remaining patients with vocal cord paralysis [7], one had old healed tuberculosis and 5 had chest roentgenogram strongly suggestive of malignancy who were referred for further evaluation. The bronchoscopist should pay special attention to unilateral vocal cord paralysis observed during routine bronchoscopy. We observed significant lung disorders present in 63% of these patients