Early Management of Acute Unilateral Vocal Fold Paralysis: Update of the Literature

Abstract

Background: Unilateral vocal fold paralysis (UVFP) often leads to significant morbidity that may include dysphonia, swallowing problems and aspiration. The best timing for medialization procedures is still controversial. Published data suggest that early intracordal injection positively affects long-term outcomes.

Objectives: To critically review current literature in order to determine if early treatment of acute UVFP influences clinical outcomes of the patients.

Type of review: Nonsystematic literature review.

Methods: A literature review was performed, using the Pubmed database. All relevant articles published in English addressing the effect of early treatment in acute unilateral focal fold paralysis were analyzed. Twenty-six articles were included due to their scientific interest.

Results: Published literature suggests that early intracordal injection in patients with UVFP reduces pulmonary infections, hospital length of stay and improves voice parameters. Also, patients who receive early intracordal injection seem to be less likely to undergo subsequent medialization thyroplasty.

Conclusions: Early intracordal injection should be offered to patients with newly diagnosed UVFP since it promotes a satisfactory position of the vocal fold and seems to improve clinical outcomes. More investigation, with long-term follow up data and treatment randomization, is necessary to develop clinical consensus for these patients.

Keywords: Dysphonia; Injection; Laryngoplasty; Larynx; Paralysis; Review; Vocal cords.