Treatment for Unilateral and Bilateral Vocal Fold Paralysis
Unilateral Vocal Fold Paralysis
Unilateral vocal fold paralysis (UVFP) is the most common form of laryngeal paralysis because the left recurrent laryngeal nerve (RLN) appears to be more prone to traumatic or surgical injury than the right RLN. Medically treated or behavioral voice therapy can be used to treat UVFP.
Behavioral Voice Therapy includes- half-swallow boom, head positioning, tuck-chin, digital manipulation, focus, tongue protrusion /i/, yawn-sigh, pitch shift up, and inhalation phonation. Also, hyperfunctional behavior is common in these patients. This behavior is responsible for most of the voice strain, neck discomfort, and fatigue that may accompany unilateral vocal fold paralysis (Rubin & Sataloff, 2007, pg. 1120).
Is surgery necessary for UVFP? – Surgery may not be necessary if the patient chooses voice therapy. For example, Heuer and colleagues studied 19 female patients and 22 male patients who had unilateral recurrent nerve paralysis and found that after excellent voice therapy, 68% of the female patients and 64% of the male patients considered their voices satisfactory and elected not to have surgery (Rubin & Sataloff, 2007, pg. 1118). In the event if surgery may be needed, preoperative voice therapy is done to help the patient while surgical decisions are pending.
Possible Surgical Options:
Medialization: procedures include injection laryngoplasty and laryngeal framework surgery. Several materials are injected to medialize the vocal fold and improve glottic competence.
Reinnervation: procedure is to prevent denervation atrophy of laryngeal muscles. Crumley reports improved vocal quality and restoration of the mucosal wave after reinnervation using the ansa cervicalis (Rubin & Sataloff, 2007, pg. 1121).
Bilateral Vocal Fold Paralysis
If a patient exhibits bilateral vocal fold paralysis, medical treatment is required. The patient may require a tracheotomy to allow the patient to eat carefully to prevent aspiration, followed by surgery to improve the size of the glottic airway.
Surgical Procedures:
Cordotomy and arytenoidectomy with or without suture lateralization of the vocal fold are the most commonly performed lateralization procedures to treat bilateral vocal fold paralysis (Rubin & Sataloff, 2007, pg. 1122).
Injection of toxin into the cricothyroid muscle results in decreased tension in the vocal fold and subsequent lateralization with airway improvement (Rubin & Sataloff, 2007, pg. 1122).
Surgical reinnervation of the muscles of the vocal folds has been successfully reported by Crumley and Izdebski (1986) (Boone, McFarlane, Von Berg, & Zraick, pg. 88).
Electrical stimulation to the cricoarytenoid muscle via implant resulted in improved vocal fold movement.
Laser surgery has been successful in decreasing open glottal space for adductor fold paralysis and laser arytenoid for bilateral abductor fold paralysis has successfully opened the glottis.
An alternative to surgery for patients with abductor VFP may be inspiratory pressure threshold training.