Management of Unilateral Vocal Cord Palsy: Case Series with Review of Literature

Abstract

Aim: To find out the vocal outcome of conservative management and temporary medialization in unilateral vocal cord palsy (UVCP) and their effectiveness in reducing the need for permanent medialization. Materials and methods: Thirty adult patients with UVCP, without structural vocal cord lesion or laryngeal malignancy were initially treated conservatively, and those without adequate response at 3 months were treated with temporary medialization. They were followed up for 6 months. Preand posttreatment voice was compared using grade, roughness, breathiness, asthenia, strain (GRBAS) scale, Voice Handicap Index (VHI), and maximum phonation time (MPT). Results: The results show 40% cases were idiopathic, whereas 33.33% had iatrogenic cause, majority, following thyroidectomy; 66.67% responded well to the conservative management. Ten patients (33.33%) did not show satisfactory improvement in the first 3 months and were treated with temporary medialization. Both the groups were comparable at the first visit. At 6 months, the improvement in all parameters was significantly more in the temporary medialization group than the conservative management group compared with their values at 3 months. Two of the 10 patients treated with injection laryngoplasty were considered for permanent medialization. The final outcome was similar in both the groups. Conclusion: Conservative management of UVCP is the standard of care. Injection laryngoplasty at 3 months achieves better voice outcome in those not fully improved by conservative management. Medialization thyroplasty should be suggested in patients failing to show the desired improvement after injection laryngoplasty. Clinical significance: The study guides in the management of UVCP, in terms of its likely cause and approach to treatment.