This protocol addresses patients with idiopathic vocal cord paralysis who were managed with an expectation of spontaneous recovery but have persistent uncompensated voice and/or aspiration — and in whom vocal fold mobility has not returned within the expected timeframe.
Vocal fold mobility has not recovered spontaneously. The prognosis for natural recovery is transient or uncertain. The patient continues to have uncompensated voice and/or aspiration, placing them at ongoing risk for pulmonary complications.
Earlier management consisted of early injection laryngoplasty with temporary injection material, voice therapy, or a watchful observation approach.
Escalation to this protocol is indicated when the primary goal — recovery of vocal fold mobility within 6–12 months from onset — has not been achieved.
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.
Early and active intervention with temporary injection materials is recommended to prevent lung complications and to ensure the quality of life of a patient with high vocal demands (strong recommendation, moderate-quality evidence).
Medialization surgical procedures can reduce the rates of penetration and aspiration in patients with acute or chronic UVFP (strong recommendation, moderate-quality evidence).
If the patient is expected to be at risk for aspiration, medialization surgical procedures should be considered at the time of diagnosis (strong recommendation, moderate-quality evidence).
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