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Laryngeal paralysis (laryngeal paresis) - Diagnosis
Last reviewed: 04.07.2025
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The high incidence of tumor-related laryngeal paralysis necessitates a thorough examination of patients to detect malignant neoplasms. When assessing the anamnesis, attention is paid to the duration of the disease, since this affects the treatment tactics.
Laboratory research
A general clinical examination is carried out.
Instrumental research
All patients with laryngeal paralysis of unknown genesis are examined according to the following algorithm:
- X-ray or computed tomography of the larynx and trachea;
- X-ray or computed tomography of the chest and mediastinum;
- X-ray of the esophagus with contrasting barium sulfate solution, which can be supplemented by endofibroesophagoscopy;
- Thyroid ultrasound, endocrinologist consultation;
- CT scan of the brain in the presence of neurological symptoms or if central paralysis is suspected, consultation with a neurologist.
The clinical and functional state of the larynx is determined by the indices of external respiration function, microlaryngoscopy and microlaryngostroboscopy of acoustic voice analysis. Electromyography and glottography are used.
Differential diagnostics
In case of unilateral laryngeal paralysis, differential diagnostics are performed with immobility of the vocal fold due to pathology of the cricoarytenoid joint, including dislocation, subluxation, arthritis and ankylosis. A sign of dislocation is considered to be the lack of symmetry of the joints, the presence of signs of inflammation in the joint area, displacement of the arytenoid cartilage and limited mobility or complete immobility of the vocal fold on the side of the injury. Edema and hyperemia of the mucous membrane in the joint area are characteristic of arthritis.
Differential diagnostics of cricoarytenoid joint pathology is performed using X-ray or computed tomography, which visualize the cricoarytenoid joint area well; electromyography data; determination of electromagnetic resonance, reflecting the state of the internal spaces between soft tissues. The most informative method is considered to be endolaryngeal probing of the joint with a probe.
Indications for consultation with other specialists
When conducting differential diagnostics of paralysis of unknown genesis, consultations with an endocrinologist, neurologist, and pulmonologist are indicated.
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