Our Summary

This research paper discusses a common cause of hoarseness, known as unilateral vocal fold palsy, which is when one side of the vocal cords is paralyzed. If this issue leads to an inability of the vocal cords to close properly, typical voice therapy might not work well and surgery might be required. A specific surgical procedure, called injection laryngoplasty, can be used to correct this problem.

The paper suggests that it’s best to perform this surgery within the first six months of diagnosis to avoid further complications. It also notes that patients whose vocal cords can’t close more than 2 millimeters might benefit most from this procedure.

The researchers mention that materials like hyaluronic acid, calcium hydroxylapatite, and fat from the patient’s own body have been used in this procedure, with effects lasting more than a year.

Though complications are rare, some people might experience allergic swelling at the injection site. Because of this, it’s recommended that patients are monitored with a laryngoscope (a tool used to view the throat) and observed for two nights after the injection.

Finally, the study notes that rest is important after the procedure, but the voice only needs to be rested for a few hours.

FAQs

  1. What is the recommended treatment for unilateral vocal fold palsy causing hoarseness?
  2. What are the potential complications of injection laryngoplasty?
  3. How long should a patient rest their voice after undergoing injection laryngoplasty?

Doctor’s Tip

A doctor may advise a patient undergoing vocal cord surgery to follow post-operative instructions carefully, including resting the voice for a few hours, attending regular follow-up appointments, and seeking immediate medical attention if they experience any unusual symptoms or complications. It is also important for the patient to communicate any concerns or questions they may have with their healthcare provider.

Suitable For

Patients who are typically recommended vocal cord surgery are those with unilateral vocal fold palsy causing hoarseness and glottis closure insufficiency. Conservative voice therapy may be limited in effectiveness, and phonosurgery, specifically injection laryngoplasty, may be indicated. Patients with glottic closure insufficiency ≤2 mm in stroboscopy may benefit from this procedure. Early intervention within the first 6 months after diagnosis is desired to avoid subsequent insufficient endogenous compensation. The duration of the effect of injection laryngoplasty can exceed 12 months with appropriate patient selection. Complications such as allergic swelling at the injection site are rare, but regular laryngoscopic monitoring and observation for two nights after injection are recommended. Resting the voice for only a few hours is necessary after the procedure.

Timeline

Before vocal cord surgery:

  1. Patient experiences hoarseness and vocal fatigue.
  2. Patient undergoes evaluation by an otolaryngologist, including laryngoscopy.
  3. Diagnosis of unilateral vocal fold palsy is confirmed.
  4. Conservative voice therapy is attempted but is not effective due to glottis closure insufficiency.
  5. Patient is recommended for vocal cord surgery, specifically injection laryngoplasty.

After vocal cord surgery:

  1. Patient undergoes injection laryngoplasty procedure to correct glottis closure insufficiency.
  2. Early intervention within the first 6 months after diagnosis is preferred to prevent inadequate endogenous compensation.
  3. Patient experiences improvement in voice quality and reduction in hoarseness.
  4. Duration of the effect of the procedure can exceed 12 months.
  5. Regular laryngoscopic monitoring is recommended to watch for rare complications such as allergic swelling at the injection site.
  6. Patient may be advised to rest their voice for a few hours after the procedure.

What to Ask Your Doctor

  1. What is the specific reason for recommending vocal cord surgery in my case?

  2. What are the potential risks and complications associated with the surgery?

  3. What is the expected outcome and recovery time following the surgery?

  4. Are there any alternative treatments or therapies that I should consider before opting for surgery?

  5. How many times have you performed this type of surgery before and what is your success rate?

  6. Will I need to follow any specific post-operative care instructions or undergo any rehabilitation therapy?

  7. How long will the effects of the surgery last and will I need any follow-up procedures in the future?

  8. Are there any lifestyle changes or vocal habits I should consider changing after the surgery to maintain the results?

  9. Will I need to undergo any further vocal cord evaluations or treatments in the future?

  10. What is the cost of the surgery and will my insurance cover it?

Reference

Authors: Reiter R, Pickhard A, Heyduck A, Brosch S, Hoffmann TK. Journal: HNO. 2020 Jun;68(6):461-472. doi: 10.1007/s00106-020-00863-8. PMID: 32377780