Initial Approach to Traumatic Vocal Cord Paralysis

Evaluation and Diagnosis

The American Academy of Otolaryngology-Head and Neck Surgery recommends laryngoscopy as an essential tool to confirm the diagnosis and evaluate the position and mobility of the vocal cords 2
The Journal of the American College of Radiology suggests that computed tomography (CT) with contrast of the neck, extended to the aortopulmonary window, is useful for the initial evaluation of vagus nerve paralysis, allowing visualization of the bony integrity of the skull base and evaluation of the entire length of the recurrent laryngeal nerve 3, 4
The American Academy of Otolaryngology-Head and Neck Surgery states that laryngeal electromyography (LEMG) can help distinguish between neurological paralysis and traumatic arytenoid dislocation, although studies are limited 5, 6
The Journal of the American College of Radiology recommends magnetic resonance imaging (MRI) to evaluate the intracranial and skull base segments of the vagus nerve when lesions are suspected at this level 3, 4

The American Academy of Otolaryngology-Head and Neck Surgery recommends voice therapy as the primary initial approach, with typical sessions 1-2 times a week for 4-8 weeks 2
The goals of voice therapy include eliminating harmful vocal behaviors, developing healthy vocal behaviors, aiding in vocal cord healing, and assisting the patient in adapting to and compensating for altered laryngeal physiology 2

The American Academy of Otolaryngology-Head and Neck Surgery suggests that injection laryngoplasty is a temporary solution that restores the position and volume of the vocal cord, and can be performed in the office under topical anesthesia or in the operating room 2
The American Academy of Otolaryngology-Head and Neck Surgery recommends that early intervention (within 6 months) with injection laryngoplasty can decrease the need for more invasive therapies in the long term 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends an initial evaluation with laryngoscopy to confirm the diagnosis, followed by imaging studies (CT of the neck with contrast) to determine the cause 2, 3, 4
The American Academy of Otolaryngology-Head and Neck Surgery suggests that patients with persistent symptoms despite voice therapy should be considered for temporary injection laryngoplasty within the first 6 months 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery states that the quality of life can be dramatically affected by dysphonia, impacting work capacity and social, family, and vocational activities 1, 2
The American Academy of Otolaryngology-Head and Neck Surgery recommends that patients should be informed that vocal cord paralysis can resolve spontaneously within a year, but may also not recover completely 2
Early identification and intervention to improve dysphonia allow the patient to return more quickly to their normal social and occupational activities 1