User:Chloe.93/sandbox

I plan to work on the definition and classification section as well as the symptoms sections of the vocal fold paresis article. I plan to reorganize these sections to make them easier to follow and straight to the point. I also plan to find more reliable references and to verify that the references that are currently being used are reliable. I plan to remove information that is not relevant to the subtitle - e.g. in the definition and classification section, it discusses what physicians tell their patients if vocal fold paresis is present. From what I have researched thus far, differences between bilateral and unilateral vocal fold paresis are not clearly outlined. I will further research the matter to determine whether it is necessary to separate the symptoms by unilateral and bilateral types of vocal fold paresis.

Definition and classification
Vocal fold paresis refers to a partial loss of input to the nerve of the vocal folds. This loss of neural input leads to reduced vocal fold mobility. It is a condition with a variable profile, as the severity of the paresis can range on a wide continuum from minor to major loss of vocal fold mobility. Vocal fold paralysis, distinguished from vocal paresis, is the total loss of vocal fold mobility due to a lack of neural input to the vocal folds. These conditions result from continuous damage to the laryngeal nerves and often lead to vocal disability. Recurrent laryngeal nerve damage is the most common cause of vocal fold paresis. The RLN is responsible for motor input to the vocal folds. Additionally, superior laryngeal nerve damage (SLN) can also lead to vocal fold paresis. The SLN is responsible for sensory input to the vocal folds. Due to its variable nature, the progression of vocal fold paresis may fluctuate, so it may be characterized differently from one evaluation to the next. Fluctuating vocal fold paresis has been observed in neurodegenerative disorders like Guillain–Barré syndrome or myasthenia gravis.

The posterior cricoarytenoid (PCA) is a muscle of the larynx that is responsible for pulling the vocal folds apart from one another. Unilateral vocal fold paresis is the term used when there is damage to the RLN on one side of the body. In unilateral vocal fold paresis, there is a lack of nerve supply to one side of the vocal fold's PCA muscle. This lack of nerve supply renders the arytenoid cartilage immobile. The RLN may be damaged during surgical procedures. The right RLN in particular, has a greater chance of being damaged during surgery due to its position in the neck. When both of the vocal folds' PCA muscles lack a nerve supply, the term bilateral vocal fold paresis is used. With bilateral vocal fold paresis, a person's airway may become blocked as the muscles are unable to pull the vocal folds apart fully.

Symptoms
Typically, patients with vocal fold paresis or paralysis are able to identify the onset of their symptoms. The most commonly reported symptom patients with either vocal fold paresis or paralysis make is having a rough voice quality. It is important to note that the symptoms of vocal fold paresis are not specific to the condition and tend to be common symptoms of other voice disorders as well. Vocal fold bowing, decreased vocal fold mobility, especially decreased mobility of the arytenoid cartilage, are often observed in vocal fold paresis. Glottal insufficiency is another common symptom observed in vocal fold paresis. In this case, the vocal folds do not come together properly. Glottal insufficiency may be hard to identify, especially when the area above the vocal folds is hyperfunctional. Hyperfunction may also make it difficult to detect the presence of vocal fold paresis. Hyperfunction of the area above the vocal folds may be considered a sign of glottal insufficiency and potentially, vocal fold paresis.

In some cases, glottal closure may appear to be normal, however, asymmetries in the vocal folds may still be present. Though voice qualities may appear normal in some cases of vocal fold paresis or paralysis, mild differences in tension between the two vocal folds of the larynx can result in changes of voice pitch, intensity and reduced vocal stamina.

Patients with either vocal fold paresis or paralysis may exhibit a breathy voice quality. This voice quality results from the increased activity of the vocal folds to compensate for the immobility of the PCA muscle(s). Patients may need to use more effort than normal when speaking and may find that their voice quiets or grows tired after speaking for a long time. This is known as vocal fatigue. Patients may also complain about having a limited pitch range  and trouble varying their pitch at quick rate. It is often difficult for the speaker to project their voice and speak loud enough to be heard in noisy environments, over background noise, or when speaking to someone from a distance. It is possible for symptoms to surface only in situations where the environmental acoustics are poor, such as outdoors. Patients may report feeling pain in the throat or experiencing bouts of choking. A patient presenting with diplophonia is of major concern as this typically means that the mass and tension of their vocal folds are asymmetrical which may also indicate vocal fold paresis.

Swallowing difficulties (dysphagia) are not commonly seen in vocal fold paresis that results from RLN damage. Dysphagia may however, suggest SLN damage. Symptoms of sensory nerve damage include: chronic coughing, the feeling of having a lump in the throat (globus sensation), hypersensitivity or abnormal sensation, spasms of the vocal folds (laryngospasms), dysphagia, pain from vocal use, and voice loss in high pitch ranges. It is possible for both the RLN and the SLN to be damaged simultaneously, so the symptoms of RLN and SLN damage may be seen independently or alongside one another.

If maladaptive compensatory strategies are used more and more to try to offset the voice difficulties, the vocal mechanisms will fatigue and the above symptoms will worsen.

Chloe, these sections are excellent!! My only notes are, in your last sentence, what do you mean by throughout the day? Can't compensatory strategies be used over many days and even become stronger over time in general? One other thing: because you discuss so many symptoms, it might be nice to have a section stating: Symptoms of vocal voice paresis include...., and then go into the section, just in case a reader wants a quick answer without reading the whole section. Overall, excellent, neutral, and well-referenced sections! I am impressed! Cassandrajc (talk) 00:04, 29 October 2016 (UTC)