This protocol applies to the patient with idiopathic unilateral vocal fold paralysis (UVFP) who presented with a compensated voice and no aspiration, was managed conservatively during the window of possible spontaneous recovery, but did not achieve recovery of vocal fold mobility within the expected timeframe.
Idiopathic UVFP with expectation of spontaneous recovery (transient or unknown prognosis), compensated voice, and no aspiration. The initial approach was appropriately conservative given the possibility of neural recovery.
Initial management — which may have included voice therapy, injection laryngoplasty with temporary injection material, or a watchful observation (wait-and-see) approach — did not meet its primary goal: recovery of vocal fold mobility within 6–12 months from onset. As the probability of spontaneous recovery declines beyond that window, definitive management becomes indicated.
DOI: 10.1177/0194599817751030
For patients with a compensated voice and no aspiration, less invasive treatment, such as a wait-and-see approach, IL with temporary material, and voice therapy are applicable, depending on the patient's need or profession, but for patients with a high vocal demand, uncompensated voice, or aspiration/dysphagia, SMPs are preferred.
Temporary IL is preferred for cases of UVFP with no apparent cause (i.e., where there is a possibility of recovery of neural function).
The declining probability of recovery over time leads us to consider the value of laryngeal framework surgery (LFS) after 6 months in patients with no precipitating cause.
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