Ätiologie, Diagnostik, Differenzialdiagnostik und Therapie von Stimmlippenparesen

Zusammenfassung

Die Ätiologie von Stimmlippenparesen ist vielfältig: z. B. postchirurgisch/traumatisch, Malignom-assoziiert oder Folge einer systemischen Erkrankung. Bleibt die Ursache unklar, so spricht man von idiopathischen Paresen. Das Hauptsymptom von einseitigen Stimmlippenparesen ist Heiserkeit aufgrund einer Glottisschlussinsuffizienz, bei beidseitigen Paresen kommt es jedoch bei guter Stimmfunktion zu Atemnot. Bei unklaren idiopathischen Paresen umfasst die Diagnostik eine CT-Untersuchung des gesamten Nervenverlaufs des N. recurrens von der Schädelbasis bis ins obere Mediastinum, jedoch nicht zwingend eine serologische Abklärung. Differenzialdiagnostisch muss bei einem Stimmlippenstillstand an neurogene aber auch an arthrogene Ursachen wie z. B. eine Aryknorpelluxation, eine Ankylose des Cricoarytenoidgelenks, eine Interarytenoidfibrose oder an eine Malignominfiltration gedacht werden. Therapeutisch kann eine Stimmtherapie erfolgsversprechend sein, diese ist jedoch für viele Patienten mit einer einseitigen Stimmlippenparese nicht ausreichend. Eine temporäre Stimmlippenaugmentation erzielt gute klinische Ergebnisse, die mit einer Thyroplastik vergleichbar sind. Bei beidseitgen Stimmlippenparesen ist das Hauptsymptom üblicherweise eine akute Dyspnoe, die eine sofortige therapeutische Intervention wie z. B. eine temporäre Tracheotomie bzw. reversible Glottiserweiterung erfordert und bei Persistenz eine permanente Glottiserweiterung z. B. durch eine Arytenoidektomie nach sich zieht.

Abstract

Etiology, Diagnosis, Differential Diagnosis and ­Therapy of Vocal Fold Paralysis

Etiology of vocal fold paralysis is broad: e. g. iatrogenic/traumatic, associated with neoplasms or with systemic diseases. The cause of idiopathic paralysis is unknown. The main symptom of unilateral vocal fold paralysis is hoarseness because of a remaining glottic gap during phonation. Patients with bilateral vocal fold paralysis typically have no impairment of the voice but dyspnea. Examination of patients with an idopathic vocal fold paralysis is a CT of the vagal nerve and recurrent laryngeal nerve from skull base to neck and mediastinum. Serological tests are not obligatory. Differential diagnosis of vocal fold immobility is vocal fold paralysis/neurological causes and arthrogene causes such as arytenoid subluxation, interarytenoid adhesion and vocal fold fixation in laryngeal carcinomas. Voice therapy is a promising approach for patients with unilateral vocal fold paralysis, but not all patients benefit sufficiently. Temporary vocal fold augmentation by injection medialization results in satisfactory voice quality that is comparable with a thyroplasty. Patients with bilateral vocal fold immobility show typically dyspnea requiring immediate therapy such as temporary tracheotomy or reversible laterofixation of the paralyzed vocal chord. If the paralysis persists a definitive enlargement of the glottic airway by eg. arytenoidectomy needs to be performed.

Schlüsselwörter

Stimmlippe - Parese - Stimme - Augmentation - Thyroplastik

Key words

vocal fold - paralysis - voice - augmentation - thyroplasty

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