What are the treatments for vocal cord paralysis?

Treatments for Vocal Cord Paralysis

Voice therapy is the first-line treatment for vocal cord paralysis, which can be used alone or as part of a comprehensive treatment approach that may include surgical interventions such as injection laryngoplasty or framework procedures depending on the severity and duration of the paralysis. 1

Non-Surgical Treatment Options

Voice Therapy

• Voice therapy is effective for vocal cord paralysis across all age groups and should be considered as the primary initial treatment approach 1
• Voice therapy is provided by certified and licensed speech-language pathologists (SLPs) who have expertise in treating voice disorders 1
• Treatment typically consists of 1-2 therapy sessions weekly for 4-8 weeks, with duration determined by the severity of the problem and patient commitment 1
• Voice therapy aims to:
  • Eliminate harmful vocal behaviors
  • Shape healthy vocal behavior
  • Assist in vocal fold wound healing
  • Help patients adjust and compensate for altered laryngeal physiology 1, 2
• Specific assistive techniques for vocal cord paralysis include:
  • Digital compression of the larynx (Seeman technique) - compressing the thyroid cartilage to improve vocal cord position 2
  • Head and neck rotation techniques to alter anatomical relationships and improve vocal cord contact 2

Supportive Measures

• Adequate hydration to maintain vocal fold health 3
• Avoiding irritants such as tobacco and alcohol 3
• Appropriate vocal rest to prevent further strain 3
• Regular physical exercise (≥3 times weekly) 3
• Avoiding noisy environments, poor air quality, and dry conditions 3

Surgical Treatment Options

Injection Laryngoplasty

• Temporary solution (typically lasting months) that restores vocal fold position and bulk 1
• Can be performed in-office under topical anesthesia or in an operating room setting 1, 4
• Materials commonly injected include hyaluronic acid gels, autologous fat, collagen, micronized human dermis, methylcellulose gel, and calcium hydroxyapatite paste 1
• Early injection (within 6 months of onset) has been shown to decrease the need for more invasive long-term therapy 1
• Provides immediate voice improvement with minimal complications 4
• Can be repeated when the injection material is resorbed 1

Framework Procedures

• Permanent surgical solution that restores vocal fold position 1
• Requires a neck incision and is performed in an operating room 1
• Provides near-immediate restoration of voice 1
• Appropriate for patients with permanent vocal cord paralysis who haven't responded adequately to less invasive treatments 1

Reinnervation Procedures

• Permanent surgical solution that aims to restore vocal fold position and bulk 1
• Final surgical outcome can take up to a year to manifest 1
• Often combined with vocal fold injection to rehabilitate voice during the healing period 1
• Requires a neck incision and is performed in an operating room 1

Treatment Algorithm

1. Initial Evaluation:

   • Laryngoscopy to confirm diagnosis and assess the position and mobility of vocal cords 1, 3
   • Document voice changes, including hoarseness, weakness, breathiness, or difficulty with volume/pitch 1

2. Early Intervention (within 6 months of onset):

   • Begin with voice therapy by a certified SLP 1
   • Consider temporary injection laryngoplasty if significant symptoms persist despite voice therapy 1, 4
   • Early intervention improves long-term prognosis with minimal morbidity 1

3. For Persistent Paralysis (beyond 6-12 months):

   • Reassess with laryngoscopy to confirm continued paralysis 3
   • Consider more permanent solutions such as framework procedures or reinnervation if voice therapy and temporary measures are insufficient 1
   • Continue voice therapy as an adjunct to surgical interventions 1

Important Considerations

• Vocal cord paralysis may be a symptom of underlying disease (including malignancy, trauma, or neurological disorders), so thorough evaluation of the etiology is essential 5
• Patients should be informed that vocal cord paralysis may resolve spontaneously within a year, but may never fully recover 1
• Quality of life can be significantly impacted by vocal cord paralysis, affecting social, family, and vocational activities 1
• The combination of surgical intervention and voice therapy often provides better outcomes than either approach alone 6
• For patients with dysphagia and aspiration due to vocal cord paralysis, medialization procedures can help improve swallowing function, though may be less effective in cases with multiple cranial neuropathies 4