This protocol addresses post-surgical vocal cord paralysis in the specific situation where the unilateral vocal fold paralysis is considered permanent — with no expected spontaneous recovery — and the patient presents with a compensated voice and no aspiration.

Clinical scenario

Permanent unilateral vocal fold paralysis (UVFP) with no expected spontaneous recovery; voice is compensated; no aspiration is present. The appropriate management pathway in this scenario differs meaningfully from cases with aspiration, dysphagia, or high vocal demand, and is shaped by the patient's individual needs and professional context.

Management approach

In this clinical situation, less invasive management options — including voice therapy — may be applicable, though the specific intervention and whether a more procedural approach is warranted depends on factors detailed in the full protocol.

References

DOI: 10.21053/ceo.2020.00409

If UVFP is considered to be permanent, patients can be treated by either IL or LFS.

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.

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).

*Surgical medialization procedures indicate injection laryngoplasty, medialization thyroplasty and/or arytenoid adduction.

View source ↗

Treatment of Post-Surgical Vocal Cord Paralysis with Permanent Unilateral Vocal Fold Paralysis, Compensated Voice, and No Aspiration