Bilateral recurrent nerve paralysis

This paper seeks to provide the reader with a state-of-the-art review of th e aetiology, diagnosis and clinical management of bilateral recurrent nerve paralysis. The recurrent laryngeal nerves a re mo re frequently involved in bilateral paralysis than any other cranial nerve. Most of the underlying lesions are iatrogenic,with thyroid surgery being the single most important causative f actor. However, a variety of different reasons can lead to such a condition . Whenever the aetiology is uncertain, a complete diagnostic work-up is man datory. Massive strider on inspiration is the key symptom. Indirect laryngoscopy co nfirms the diagnosis. Laryngeal electromyography is of great value because it differentiates between paralysis and ankylosis of the cricoarytenoid joi nt. Moreover, in many cases, laryngeal electromyography yields reliable pro gnosis of clinical outcome. While unfavorable results can be predicted with high accuracy, correct prognosis of complete recovery is more difficult. Clinical management is surgical in the vast majority of ca ses. A variety o f endoscopic techniques for widening the glottic airway are available today and are discussed in detail. Compared to permanent tracheostomy, these pro cedures have much less impact on the patient's quality of life and should b e preferred whenever possible. Since such an operation is irreversible,a de cision should be made only in the presence of a reliable electrophysiologic al prognosis and/or after 6-9 months of watchful waiting. Inevitably, voice quality is traded for airway normalisation. However, modern surgical techn iques accomplish very tolerable phonatory results. Timing,type and extent o f surgery need to be customised for every patient individually.