Idiopathic vocal cord paralysis
ICD-10 J38.0 · ICD-11 CA0H.0.1

Treatment of Idiopathic Vocal Cord Paralysis with Aspiration When Spontaneous Recovery Is Not Expected

This protocol addresses permanent unilateral vocal fold paralysis (UVFP) in which no spontaneous recovery of vocal fold mobility is anticipated, and the patient presents with uncompensated voice and/or aspiration.

Clinical scenario: Permanent UVFP with no expected recovery of vocal fold mobility, accompanied by uncompensated voice and/or aspiration. In the presence of a profound glottic gap and/or aspiration, less invasive or conservative approaches are generally not sufficient.
Treatment approach (partial overview)

Surgical medialization procedures are preferred in this scenario. The selection between available surgical options — and whether any adjunctive procedure is indicated — depends on patient-specific factors including life expectancy, comorbidities, anatomical findings, and patient preference. The complete selection criteria, procedural algorithm, and alternative options are set out in the full protocol.

Clinical goals

Reduction of the glottal gap; reduction of penetration and aspiration.

Instant Access to Structured Evidence-Based Regimens

References

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.

However, for patients with a profound gap and/or aspiration, surgical medialization procedures (SMPs) are preferred (see KQ 16).

IL is preferred for patients with a short life expectancy or significant comorbidities, and for those who do not want to sustain a visible neck scar (weak recommendation, low-quality evidence).

Both MT and AA offer a permanent solution for treating UVFP by reducing the glottal gap.

Medialization surgical procedures can reduce the rates of penetration and aspiration in patients with acute or chronic UVFP (strong recommendation, moderate-quality evidence).

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