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Plan for Diagnosis section of Vocal Fold Paresis article:
Elaborate on voice assessment techniques: indirect laryngoscopy, flexible fiberoptic laryngoscopy, video stroboscopy, CXR, CT, MRI, barium swallow, EMG
Simplify language, add more current sources
Merati, A. L., Halum, S. L., & Smith, T. L. (September 01, 2006). Diagnostic Testing for Vocal Fold Paralysis: Survey of Practice and Evidence-Based Medicine Review. The Laryngoscope, 116, 9, 1539-1552.
Misono, S., & Merati, A. L. (January 01, 2012). Evidence-based practice: evaluation and management of unilateral vocal fold paralysis. Otolaryngologic Clinics of North America,45, 5, 1083-108.
Rickert, S. M., Childs, L. F., Carey, B. T., Murry, T., & Sulica, L. (January 01, 2012). Laryngeal electromyography for prognosis of vocal fold palsy: A Meta-Analysis. The Laryngoscope, 122, 1, 158-161.
Syamal, M. N., & Benninger, M. S. (January 01, 2016). Vocal fold paresis: a review of clinical presentation, differential diagnosis, and prognostic indicators. Current Opinion in Otolaryngology & Head and Neck Surgery, 24, 3, 197-202.
There are a variety of ways to diagnose vocal fold paralysis. Important indications of possible causes can be revealed in the patient's medical history, which may inform which diagnostic approach is taken.
Voice diagnostics are used to assess voice quality and vocal performance. Voice assessment is necessary to plan and estimate the success of a possible speech therapy.[12]
An auditory-perceptual evaluation is conducted by a Speech-Language Pathologist (S-LP), and allows changes in voice quality to be monitored over time. There are two scales which can be used to subjectively measure voice quality: the GRBAS (grade, roughness, breathiness, asthenia, strain) and the CAPE-V (Consensus Auditory Perceptual Evaluation of Voice). The GRBAS is used to rate the patient's voice quality on 5 dimensions: grade (overall severity), roughness, breathiness, asthenia (weakness) and strain. Each dimension will receive a severity rating from 0 (not present) to 3 (severe). This allows the S-LP to make a judgment about the overall severity of the voice quality. The CAPE-V is used in a similar manner, rating of the dimensions of voice quality on a subjective scale from 0-100, and using this to determine an overall severity score.
In incompletely or only partially healed paralyses, stroboscopic larynx examinations yield a type of slow motion picture to assess tension and fine mobility of the vocal folds during vocalization. Stroboscopy[3][4] and voice assessment are important to establish an individual treatment plan to improve the voice.
Breathing tests (spirometry, body plethysmography) are used to measure the impairment of respiratory flow through the larynx, particularly in patients with bilateral vocal fold paralysis.
Electromyography of the laryngeal muscles (larynx EMG),[1][13] which measures the electrical activity of the larynx muscles via thin needle electrodes, allows better differentiation between a neural lesion and other causes of impaired mobility of the vocal fold and localization of the lesion along the nerve. For example, the larynx EMG can, within limits, provide a prognosis of the development of a recurrent laryngeal nerve paralysis. While patients with a poor chance of healing can be identified at an early stage, this advanced examination technique is not available in all treatment centers.
The treating physician must view all examination results combined[4] and establish an individual diagnosis and treatment plan for each patient.