Treatment of Vocal Cord Paralysis

Introduction to Treatment Options

The American Academy of Otolaryngology-Head and Neck Surgery recommends voice therapy as 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, 2

Voice therapy is effective for vocal cord paralysis across all age groups and should be considered as the primary initial treatment approach, with treatment typically consisting of 1-2 therapy sessions weekly for 4-8 weeks 3, 1
Voice therapy aims to eliminate harmful vocal behaviors, shape healthy vocal behavior, assist in vocal fold wound healing, and help patients adjust and compensate for altered laryngeal physiology 3, 2
The American Academy of Otolaryngology-Head and Neck Surgery suggests that adequate hydration is essential to maintain vocal fold health 4
Avoiding irritants such as tobacco and alcohol, and appropriate vocal rest to prevent further strain are also recommended 4

Injection laryngoplasty is a temporary solution that restores vocal fold position and bulk, and can be performed in-office under topical anesthesia or in an operating room setting 2
Early injection (within 6 months of onset) has been shown to decrease the need for more invasive long-term therapy 5, 6
Framework procedures are a permanent surgical solution that restores vocal fold position, and requires a neck incision and is performed in an operating room 2
Reinnervation procedures are a permanent surgical solution that aims to restore vocal fold position and bulk, and often combined with vocal fold injection to rehabilitate voice during the healing period 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends that initial evaluation should include laryngoscopy to confirm diagnosis and assess the position and mobility of vocal cords 7, 4
Early intervention (within 6 months of onset) should begin with voice therapy by a certified SLP, and consider temporary injection laryngoplasty if significant symptoms persist despite voice therapy 3, 1, 5, 6
For persistent paralysis (beyond 6-12 months), reassess with laryngoscopy to confirm continued paralysis, and consider more permanent solutions such as framework procedures or reinnervation if voice therapy and temporary measures are insufficient 4, 2

Patients should be informed that vocal cord paralysis may resolve spontaneously within a year, but may never fully recover 2
Quality of life can be significantly impacted by vocal cord paralysis, affecting social, family, and vocational activities 5, 6

The American Academy of Otolaryngology-Head and Neck Surgery explicitly recognizes injection laryngoplasty as a legitimate rehabilitative option for unilateral vocal fold paralysis, providing temporary improvement by restoring vocal fold position and bulk 8, 9
Injection laryngoplasty can be repeated when the injection material disappears, which directly applies to patients with recurrent symptoms 8, 9
Autologous fat is specifically listed among commonly injected agents for vocal fold augmentation, alongside hyaluronic acid gels, collagen, and other materials 8, 9

Recent voice deterioration after a period of stability suggests reabsorption of the previously injected fat, which is an expected and well-documented phenomenon 8, 9

Repeat injection is less invasive than permanent surgical alternatives, such as framework procedures or reinnervation, which require neck incisions and operating room procedures 8, 9

The American Academy of Otolaryngology-Head and Neck Surgery guidelines explicitly endorse injection laryngoplasty with various materials, including autologous fat, as a rehabilitative option for unilateral vocal fold paralysis 8, 9
The procedure is repeatable by design, as the temporary nature of the improvement is a known characteristic, not a treatment failure 8, 9

The patient should be counseled that voice quality and swallowing function may not stabilize for at least 6 months post-treatment 10
Serial assessments should be performed to evaluate treatment response and determine if additional interventions are needed 10
If multiple repeat injections are required, consideration should eventually be given to more permanent solutions, such as framework procedures or reinnervation 8, 9