When idiopathic unilateral vocal fold paralysis (UVFP) is deemed permanent — with no expectation of spontaneous recovery of vocal fold mobility — and the patient presents with a compensated voice and no aspiration, a considered management strategy is required. The appropriate approach balances the degree of vocal impairment against the patient's functional demands.
This protocol applies when UVFP is considered permanent, voice compensation is present, and aspiration is absent. The clinical situation differs meaningfully from cases with uncompensated voice or active dysphagia. For patients with a compensated voice and no aspiration, the range of applicable interventions is broader, and the urgency of surgical medialization is lower — but vocal demand and patient preference remain central to decision-making.
Management options in this setting include conservative measures as well as procedural interventions. The decision between approaches depends on patient-specific factors including vocal demand and clinical profile.
The full structured protocol details the specific options, their sequencing, and the criteria used to select among them — including when each intervention is most applicable.
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.
If UVFP is considered to be permanent, patients can be treated by either IL or LFS.
In patients with mild symptoms and adequate airway protection, several options may be considered, including a wait-and-see approach, voice therapy, and medialization procedures (see KQ 5–15).
Voice therapy may be used to improve voice outcomes for patients with mild symptoms or if surgical medialization procedures are not available (strong recommendation, low-quality evidence).
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