Arytenoid appearance and vertical level difference between the paralyzed and innervated vocal cords

Objectives/Hypothesis: In unilateral vocal fold paralysis, it has been gene rally accepted that the paralyzed vocal fold presents at a higher level tha n a normally innervated vocal fold. In this study, we correlate the appeara nces of the paralyzed arytenoid and the differences in level between the pa ralyzed and innervated vocal folds. Study Design: Retrospective review usin g video-recorded images of larynx. Methods: A total of 38 patients were sel ected for this study who reported symptoms of voice change attributable to a paralyzed vocal fold unilaterally. Video recordings were obtained using t he laryngeal telescope. The heights were assessed according to the paralyze d positions, status (inspiration or phonation), and appearances of the para lyzed arytenoid. The appearances of paralyzed arytenoid were further clarif ied as the portions of the medial surface of the arytenoid that were visual ized. Results: In medial paralysis, the paralyzed vocal fold appeared mainl y as being at an equal vertical level or as having no distinct difference f rom normal vocal fold during phonation. However, a few cases of medial para lysis showed a lower than normal or higher than normal vocal fold during ph onation, depending on the appearance of the paralyzed arytenoid. In lateral paralysis, most of the paralyzed vocal folds were not higher than the inne rvated vocal folds during phonation. Conclusions: The heights of paralyzed vocal folds were depending on the paralyzed positions, the status of the la rynx, and appearances of the paralyzed arytenoid. The fact that the paralyz ed vocal fold is at a higher level than the normal vocal fold should be rec onsidered.