Management of Unilateral Vocal Fold Paralysis/Paresis: A Laryngologist's Perspective

2012 ◽  
Vol 22 (3) ◽  
pp. 121-130
Author(s):  
Mark Courey
Keyword(s):  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Speech Language Pathology ◽  
Management Options ◽  
Vocal Fold Paresis ◽  
University Of Utah ◽  
Additional Information ◽  
Language Pathology

This manuscript is a follow up to a panel presentation on “Vocal Fold Paresis & Paralysis: Controversies in Evaluation & Management,” which was held during the 2011 American Speech-Language-Hearing Association (ASHA) Convention in San Diego, California. In addition to me, the other members of the panel included Sarah L. Schneider, MS, CCC-SLP, Director, Speech-Language Pathology Service, UCSF Voice and Swallowing Center; Nelson Roy, PhD, Professor, Speech & Language Pathology, Department of Communication Sciences & Disorders, University of Utah; and Marshall Smith, MD, Professor of Otolaryngology, Department of Surgery, University of Utah. During the panel, I was tasked with presenting the reasons for controversies in the diagnosis and management of vocal fold paralysis. In this manuscript, I will summarize my portion of that presentation and will provide additional information on management options for unilateral vocal fold paralysis (UVFP) from the perspective of a laryngologist.

Results of Fascial Augmentation in Unilateral Vocal Fold Paralysis

2002 ◽  
Vol 111 (6) ◽  
pp. 523-529 ◽  
Author(s):  
Petri Reijonen ◽  
Sari Lehikoinen-Söderlund ◽  
Heikki Rihkanen
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Inexpensive Method ◽  
Maximum Phonation Time ◽  
Perceptual Evaluation

The objective of this study was to evaluate the effects on voice quality of augmentation by injection of minced fascia in patients with unilateral vocal fold paralysis. Preoperative and postoperative voice samples from 14 patients (6 men and 8 women; mean age, 59 years) were analyzed by computerized acoustic analysis and blinded perceptual evaluation. Statistically significant improvements were seen in perturbation measurements (jitter and shimmer), noise-to-harmonics ratio, and maximum phonation time. A panel of evaluators rated 10 of the 14 postoperative voices as normal or near-normal. Injection laryngoplasty with minced fascia offers a new, effective, well-tolerated, and inexpensive method to medialize a paralyzed vocal fold. The graft seems to survive well, as indicated by good vocal results with a follow-up ranging from 5 to 32 months.

S191 – Unilateral Vocal Fold Paralysis: Medialization Results

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P191-P192
Author(s):  
Donna Lundy ◽  
Roy R Casiano ◽  
Mario Alberto Landera ◽  
Michael Bublik
Keyword(s):  
Vocal Fold ◽  
Demographic Data ◽  
Vocal Fold Paralysis ◽  
Long Term Results ◽  
Unilateral Vocal Fold Paralysis ◽  
Glottal Closure ◽  
Voice Outcome ◽  
Glottal Insufficiency

Objectives Management of glottal insufficiency due to unilateral vocal fold paralysis (UVFP) has evolved from trans-oral injection to external thyroplasty to revisited injections (transoral or transcutaneous). Currently, preference is given to the less invasive injection medialization. Multiple injectable materials have been utilized with newer ones being introduced to manage concerns over permanency and vocal fold vibratory patterns. The purpose of this study is to evaluate the long-term results of injection medialization for UVFP in terms of stability of glottal closure and voice outcome vs. need for reinjection. Methods All patients with UVFP that underwent injection medialization and had follow-up studies more than 6 months were eligible for inclusion. Parameters studied included demographic data (age, gender), side of paralysis, etiology, degree of pre-injection glottal insufficiency, length of follow-up, degree of post-injection glottal closure, mucosal wave resolution, and Voice Handicap Index. Results 146 patients were identified with a mean age of 61.7 years (17–94); males (55%) and females (45%). Etiology was idiopathic (56%); iatrogenic (48%); tumor-related (9%); trauma (3%); and neurologic (2%). Degree of glottal insufficiency was mild (21%); moderate (29%); and severe (50%). Material injected was Cymetra in 80 patients and Radiesse in 66 patients. 45 (33%) patients underwent more than 1 injection. Details of patients requiring repeat injections with regards to the material injected and the other parameters will be presented. Conclusions Injection medialization via a transcutaneous approach has long-lasting results making it an appropriate minimally-invasive option for long-term medialization for UVFP.

Novel Approach of Medialization Thyroplasty with Arytenoid Adduction Performed under General Anesthesia with a Laryngeal Mask

2011 ◽  
Vol 146 (2) ◽  
pp. 266-271 ◽  
Author(s):  
Nicholas W. Stow ◽  
Jennifer W. Lee ◽  
Ian E. Cole
Keyword(s):  
Vocal Fold ◽  
Case Series ◽  
Vocal Fold Paralysis ◽  
Laryngeal Mask ◽  
Unilateral Vocal Fold Paralysis ◽  
Maximum Phonation Time ◽  
Arytenoid Adduction ◽  
Medialization Thyroplasty ◽  
The Voice

Objective. To objectively assess the voice outcomes of patients with unilateral vocal fold paralysis treated with medialization thyroplasty and arytenoid adduction suture. Study Design. Case series of patients who underwent medialization thyroplasty and arytenoid adduction suture. Preoperative and postoperative voice testing was performed and the data were compared by statistical analysis. Setting. Tertiary referral teaching hospital in Sydney, Australia. Subjects. All patients had a unilateral vocal fold paralysis, with a large posterior glottic gap and vocal symptoms affecting their quality of life. Methods. Thirteen patients with a diagnosis of a unilateral vocal fold paralysis with a large posterior glottic gap, vocal symptoms, and total denervation of the vocal fold underwent medialization thyroplasty and arytenoid adduction suture. The surgery was performed in a novel method under a general anesthetic using a laryngeal mask and with direct intraoperative endoscopic feedback. Preoperative and postoperative measures of voice performance were compared, including acoustic analysis (fundamental frequency, speech intensity against quiet and loud background noise, speech rate) and aerodynamic assessment (airflow, maximum phonation time). Results. Medialization thyroplasty with arytenoid adduction suture significantly improved aerodynamic assessment and phonation duration for both male and female subjects overall. There were 2 of 13 treatment failures. Median follow-up time was 6 months. Conclusion. Preliminary results indicate that in selected patients with vocal fold paralysis, medialization thyroplasty with arytenoid adduction suture leads to significant improvements in objective voice measures. Longer follow-up data are required to further quantify the voice outcomes after this procedure.

Teflon Laryngoplasty: An Acoustical and Perceptual Study

1978 ◽  
Vol 43 (4) ◽  
pp. 496-505 ◽  
Author(s):  
Alon R. Reich ◽  
Jay W. Lerman
Keyword(s):  
Vocal Fold ◽  
Acoustic Properties ◽  
Unilateral Vocal Fold Paralysis ◽  
Speech Language Pathology ◽  
Speech Language Pathologist ◽  
Language Pathology ◽  
History Of ◽  
Harmonic Components ◽  
Perceptual Aspect ◽  
Frictional Noise

A 61-year-old male with a 24-year history of unilateral vocal fold paralysis was evaluated by a speech-language pathologist and an otolaryngologist for 52 weeks following Teflon injection. Tape recordings of the patient’s voice were obtained one week prior to and one, eight, 20, and 52 weeks subsequent to Teflon injection. The recorded samples were presented in the backward-play mode to a panel of speech-language pathology graduate students to obtain ratings of the degree of hoarseness, roughness, and pleasantness. Results of the perceptual aspect of this study revealed a general reduction in perceived hoarseness and an enhancement of perceived pleasantness following Teflon injection. Measurement of selected acoustic properties revealed a lowering of median fundamental frequency, a reduction of fundamental aperiodicity for isolated but not excerpted vowels, an elimination of certain frictional noise components, and an increase of certain harmonic components following Teflon injection.

Autologous Fat Injection for Unilateral Vocal Fold Paralysis

1996 ◽  
Vol 105 (8) ◽  
pp. 602-606 ◽  
Author(s):  
Maisie L. Shindo ◽  
Lauren S. Zaretsky ◽  
Dale H. Rice
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Fat Injection ◽  
Autologous Fat ◽  
The Voice ◽  
Fat Volume

This study evaluates the efficacy of autologous fat injection for medialization of the paralyzed vocal fold. In 21 patients with unilateral vocal fold paralysis, autologous abdominal fat was injected into the thyroarytenoid muscle to achieve medialization. All patients were followed up with serial videolaryngoscopy and voice evaluation. At 2 months' follow-up, the voice was judged to be excellent in 10 patients, slightly breathy but significantly better than the preoperative voice in 6 patients, and markedly breathy in 4 patients. At 3 to 4 months' follow-up, of the 10 patients with excellent results, 5 maintained an excellent voice, 3 had developed slight breathiness, and 1 had developed severe breathiness. Long-term (6 to 12 months) results were available in 11 patients, and all of them maintained the same voice quality that was noted during the 3 to 4 months' examination. Magnetic resonance imaging of the larynx was obtained in 7 patients at intervals ranging from 1 to 7 months and compared to the baseline scan obtained at 1 week postoperative to assess the amount of fat remaining in the muscle. The images showed fat volume to persist, but a decrease in the fat signal was observed over time. The results suggest that the duration of medialization with autologous fat is variable, but appears to last at least 2 to 3 months. This loss of volume after 3 months seems to be due to absorption of the fat and possibly muscle atrophy. Autologous fat injection is relatively safe and easy to perform, and is an ideal method of temporary vocal fold medialization in patients in whom return of vocal fold function is expected.

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