This protocol addresses unilateral vocal fold paralysis (UVFP) that arises as a post-surgical complication, in cases where spontaneous recovery of vocal fold mobility is anticipated. Despite the prospect of recovery, the patient presents with an uncompensated voice, aspiration, or both — creating an immediate clinical burden that warrants active management rather than observation alone.
The key features that define this sub-population are the expectation of spontaneous recovery of vocal fold mobility alongside currently uncompensated voice function and/or aspiration. For patients with a compensated voice and no aspiration, less invasive approaches may suffice; however, the presence of an uncompensated voice, high vocal demand, or aspiration shifts the clinical calculus toward earlier, more active intervention.
Management in this setting involves a laryngeal intervention using a temporary approach — chosen specifically because spontaneous recovery remains possible. Voice therapy may also be considered as part of the plan. The full protocol specifies which intervention is preferred, the timing considerations, and the evidence strength behind each option.
DOI: 10.21053/ceo.2020.00409
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.
IL can be applied at any stage of UVFP. 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).
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