Overview
Vocal cord paralysis involves the loss of mobility in one or both vocal folds, leading to symptoms such as hoarseness, dysphagia, dyspnea, and in severe cases, respiratory distress 18.Diagnosis
Clinical Presentation: Hoarseness, stridor, dysphagia, and aspiration risk 18.
Diagnostic Tests:
- Videostroboscopy: Visualizes vocal fold movement 7.
- Laryngoscopy: Direct visualization of vocal cords 18.
- Electlaryngography: Assesses vocal fold vibration and function 7.
Grading: Often assessed using patient-reported outcome measures like CoPE, VHI-10, EAT-10, and DI 1.Management
First-Line Treatments:
- Medical Management: Speech therapy, voice rest, and hydration 18.
- Surgical Interventions:
- Injection Laryngoplasty: For unilateral paralysis, especially in older children and adults 2.
- Endoscopic Laterofixation: In bilateral cases, particularly in pediatric patients 3.
Adjunctive Treatments:
- Reinnervation Procedures: To restore nerve function 8.
- Tracheotomy: For severe respiratory compromise 8.
Material Use: Gore-Tex for medialization laryngoplasty shows biocompatibility and safety in animal studies 4.Special Populations
Pediatrics:
- Unilateral Paralysis: Often managed medically initially; surgical options like injection laryngoplasty considered if medical management fails 2.
- Bilateral Paralysis: May require endoscopic laterofixation or tracheotomy due to severe respiratory symptoms 3.
Comorbidities: No specific management adjustments mentioned in abstracts 69.Key Recommendations
Utilize patient-reported outcome measures (CoPE, VHI-10, EAT-10, DI) for comprehensive assessment of vocal cord paralysis impact (Evidence: Moderate 1).
Consider injection laryngoplasty as a first-line surgical intervention for persistent symptoms in unilateral vocal cord paralysis, especially in older children and adults (Evidence: Expert opinion 2).
For bilateral vocal cord paralysis in children, endoscopic laterofixation can be effective in managing severe respiratory symptoms (Evidence: Moderate 3).
Evaluate the potential use of Gore-Tex in medialization laryngoplasty due to its demonstrated biocompatibility and safety in animal models (Evidence: Weak 4).
Early recognition and intervention, including tracheotomy if necessary, are critical in managing vocal cord paralysis in small children to prevent respiratory distress (Evidence: Expert opinion 8).References
1 Marshall CR, Lappin JJ, Crosby TW, Stockton SD, Ma Y, Young VN et al.. Evaluating the Role of the CoPE in Relation to Established Laryngology PROMs. The Laryngoscope 2026. link
2 Jang M, Gregory S, Jabbour J, Robey TC, Sulman C, Chun R. Injection laryngoplasty in infants with unilateral vocal cord paralysis: A survey of ASPO members. International journal of pediatric otorhinolaryngology 2020. link
3 Lidia ZG, Magdalena F, Mieczyslaw C. Endoscopic laterofixation in bilateral vocal cords paralysis in children. International journal of pediatric otorhinolaryngology 2010. link
4 Durucu C, Kanlikama M, Mumbuc S, Bayazit Y, Bakir K, Karatas E. Medialization laryngoplasty with gore-tex: an animal study. Journal of voice : official journal of the Voice Foundation 2007. link
5 Fang TJ, Li HY, Gliklich RE, Chen YH, Wang PC. Assessment of Chinese-version voice outcome survey in patients with unilateral vocal cord paralysis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2007. link
6 Berkowitz RG. Congenital bilateral adductor vocal cord paralysis. The Annals of otology, rhinology, and laryngology 2003. link
7 Sercarz JA, Berke GS, Gerratt BR, Kreiman J, Ming Y, Natividad M. Synchronizing videostroboscopic images of human laryngeal vibration with physiological signals. American journal of otolaryngology 1992. link90096-c)
8 Tucker HM. Vocal cord paralysis in small children: principles in management. The Annals of otology, rhinology, and laryngology 1986. link
9 Nuutinen J, Kärjä J. Bilateral vocal cord paralysis following general anesthesia. The Laryngoscope 1981. link