The paresis podule.In 2000, a 43-year-old woman presented with dysphonia dysphonia /dys·pho·nia/ (-fo´ne-ah) a voice impairment or speech disorder.dysphon´ic dys·pho·ni·a n. Difficulty in speaking, usually evidenced by hoarseness. and glottic glot·tic adj. 1. Of or relating to the tongue. 2. Of or relating to the glottis. glottic pertaining to (1) the glottis, or (2) the tongue. incompetence (glottal glot·tal adj. Of or relating to the glottis. glottal (glot´ closure index (1) [GCI]: 14) after she had undergone an anterior cervical fusion. Endoscopic examination revealed right vocal fold paralysis, and laryngeal electromyography detected a right recurrent laryngeal neuropathy. Six months later, the patient's breathy dysphonia and glottic incompetence had improved only minimally (GCI: 10). Laryngeal examination revealed a paretic paretic /pa·ret·ic/ (pah-ret´ik) pertaining to or affected with paresis. right vocal fold and a mild phonatory glottic gap. Another 6 months later, the dysphonia and glottic incompetence had further improved (GCI: 3). Examination revealed a persistent right vocal fold paresis paresis /pa·re·sis/ (pah-re´sis) slight or incomplete paralysis. general paresis paralytic dementia; a form of neurosyphilis in which chronic meningoencephalitis causes gradual loss of cortical , a sessile sessile /ses·sile/ (ses´il) attached by a broad base, as opposed to being pedunculated or stalked. ses·sile adj. Permanently attached or fixed; not free-moving. pseudocyst pseudocyst /pseu·do·cyst/ (soo´do-sist) 1. an abnormal or dilated space resembling a cyst but not lined with epithelium. 2. (unilateral Reinke's edema), and reasonably good glottic closure on phonation pho·na·tion n. The utterance of sounds through the use of the vocal cords; vocalization. pho  na·to (figure).
[FIGURE OMITTED] The term paresis podule is derived from the lesion's pod-like appearance and nodule-like position on the free edge of the vocal fold. The classic paresis podule is a small blister-like lesion (pseudocyst) at the middle of the striking zone that develops in association with vocal fold paresis. (2) Persistent pseudocysts sometimes take on the appearance of unilateral Reinke's edema. These pseudocysts occur because vocal fold paresis produces an asymmetric, effortful closure in the striking zone that results in increased shearing forces, microvascular damage, and subsequent pseudocyst formation. Patients with a paresis podule who fail to improve with conservative measures, including aggressive antireflux and voice therapy, are candidates for surgical treatment. To prevent recurrence, surgical intervention should address the removal of the paresis podule, as well as simultaneous treatment of the underlying glottic closure problem. The authors prefer either medialization laryngoplasty or injection augmentation (e.g., lipoinjection). In the case described herein, no surgical intervention was recommended because the patient's paresis podule functioned to correct her paresis-associated glottic gap. Surgery may become necessary in the future. References (1.) Koufman JA. Bach KK, Belafsky PC, et al. The validity and reliability of the glottal closure index (GCI). Presented at a meeting of the Western Section Triological Society; Feb. 3, 2002: Pasadena, Calif. (2.)Koufman JA, Belafsky PC. Unilateral or localized Reinke's edema (pseudocyst) as a manifestation of vocal fold paresis: The paresis podule. Laryngoscope 2001:111:576-80. Stacey L. Halum, MD; Jamie A. Koufman, MD From the Center for Voice and Swallowing Disorders of Wake Forest University, Winston-Salem, N.C.: www.wfubmc.edu/voice |
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