Skip to main content
SpringerLink
Log in

Decision-Making in Patients with Bilateral Vocal Fold Paralysis with Glottal Insufficiency: Balancing Voice Versus Airway

  • Chapter
  • First Online:
Decision Making in Vocal Fold Paralysis

  • 548 Accesses

Abstract

Surgery of patient with bilateral vocal fold paralysis must often balance the effects of surgical treatment on both the voice and airway. In both the acute and the chronic management of the patient with bilateral vocal fold paralysis, the decision must incorporate the prognosis of the injury and the potential for recovery, the severity of the injury, and the functional needs of the patient. Better airway may occasionally need to be sacrificed for better voice and vice versa. Impaired cough and impaired swallow may also need to be considered where permanent laryngeal dilation is being done. As part of the workup, advanced functional studies of respiration and voice may incorporate fiber-optic and rigid laryngoscopy with stroboscopy, pulmonary function testing with flow loop studies, laryngeal electromyography, and CT radiographic imaging. In the management of patients with acute vocal fold paralysis, temporary tracheostomy, arytenoid lateralization suture, and Botox injection into the adductors may have a role in improving airway, while injection laryngoplasty has a role in improving voice. In consideration of the permanent procedures to open the airway in patient with bilateral vocal fold paralysis, static procedures such as open and endoscopic arytenoidectomy, open arytenoid lateralization procedures, and transverse cordotomy with myectomy may be considered. Lipo injection, bilateral medialization laryngoplasty, and medialization laryngoplasty with or without arytenoid adduction have a role in patients with voice disturbance with glottal incompetence. Nonselective and selective reinnervation can be performed in patients to achieve dynamic rehabilitation and restore function.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Benninger MS, Crumley RL, Ford CN, et al. Evaluation and treatment of the unilateral paralyzed vocal fold. Otolaryngol Head Neck Surg. 1994;111:497–508.

    Article  CAS  Google Scholar 

  2. Benninger MS, Gillen JB, Altman JS. Changing etiology of vocal fold immobility. Laryngoscope. 1998;108:1346–50.

    Article  CAS  Google Scholar 

  3. Francis DO, Pearce EC, Ni S, Garrett CG, Penson DF. Epidemiology of vocal fold paralyses after total thyroidectomy for well-differentiated thyroid cancer in a Medicare population. Otolaryngol Head Neck Surg. 2014;150:548–57.

    Article  Google Scholar 

  4. Morpeth JF, Williams MF. Vocal fold paralysis after anterior cervical diskectomy and fusion. Laryngoscope. 2000;110:43–6.

    Article  CAS  Google Scholar 

  5. Ko HC, Lee LA, Li HY, Fang TJ. Etiologic features in patients with unilateral vocal fold paralysis in Taiwan. Chang Gung Med J. 2009;32:290–6.

    PubMed  Google Scholar 

  6. Al-Khtoum N, Shawakfeh N, Al-Safadi E, Al-Momani O, Hamasha K. Acquired unilateral vocal fold paralysis: retrospective analysis of a single institutional experience. N Am J Med Sci. 2013;5:699–702.

    Article  Google Scholar 

  7. Hillel AD, Benninger M, Blitzer A, et al. Evaluation and management of bilateral vocal cord immobility. Otolaryngol Head Neck Surg. 1999;121:760–5.

    Article  CAS  Google Scholar 

  8. Li Y, Garrett G, Zealear D. Current treatment options for bilateral vocal fold paralysis: a state-of-the-art review. Clin Exp Otorhinolaryngol. 2017;10:203–12.

    Article  CAS  Google Scholar 

  9. Su WF, Liu SC, Tang WS, Yang MC, Lin YY, Huang TT. Suture lateralization in patients with bilateral vocal fold paralysis. J Voice. 2014;28:644–51.

    Article  Google Scholar 

  10. Hong YT, Park MJ, Shin YJ, Minh PHN, Hong KH. The phonetic characteristics in patients of bilateral vocal fold paralysis without tracheotomy. Clin Exp Otorhinolaryngol. 2017;10:272–7.

    Article  Google Scholar 

  11. Nawka T, Sittel C, Gugatschka M, et al. Permanent transoral surgery of bilateral vocal fold paralysis: a prospective multi-center trial. Laryngoscope. 2015;125:1401–8.

    Article  Google Scholar 

  12. Siu J, Tam S, Fung K. A comparison of outcomes in interventions for unilateral vocal fold paralysis: a systematic review. Laryngoscope. 2016;126(7):1616–24.

    Article  Google Scholar 

  13. Mueller AH, Hagen R, Pototschnig C, et al. Laryngeal pacing for bilateral vocal fold paralysis: voice and respiratory aspects. Laryngoscope. 2017;127:1838–44.

    Article  Google Scholar 

  14. Naunheim MR, Song PC, Franco RA, Alkire BC, Shrime MG. Surgical management of bilateral vocal fold paralysis: a cost-effectiveness comparison of two treatments. Laryngoscope. 2017;127:691–7.

    Article  Google Scholar 

  15. Aynehchi BB, McCoul ED, Sundaram K. Systematic review of laryngeal reinnervation techniques. Otolaryngol Head Neck Surg. 2010;143:749–59.

    Article  Google Scholar 

  16. Yilmaz T, Altuntas OM, Suslu N, et al. Total and partial laser arytenoidectomy for bilateral vocal fold paralysis. BioMed Res Int. 2016;2016:3601612.

    PubMed  PubMed Central  Google Scholar 

  17. Marina MB, Marie JP, Birchall MA. Laryngeal reinnervation for bilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg. 2011;19:434–8.

    Article  Google Scholar 

  18. Lewis S, Woo P. Botulinum toxin in management of synkinesis in patients with unilateral and bilateral vocal fold paralysis. Laryngoscope. 2018;128:447–50.

    Article  Google Scholar 

  19. Crumley RL. Laryngeal synkinesis revisited. Ann Otol Rhinol Laryngol. 2000;109:365–71.

    Article  CAS  Google Scholar 

  20. Li Y, Huang S, Zealear D. An implantable system for in vivo chronic electromyographic study in the larynx. Muscle Nerve. 2017;55:706–14.

    Article  Google Scholar 

  21. Woodman DG. Rehabilitation of the larynx in cases of bilateral abductor paralysis: open approach to arytenoidectomy, with report of the past four years’ experience. Arch Otolaryngol. 1949;50:91–5.

    Article  CAS  Google Scholar 

  22. Woodson G. Arytenoid abduction: indications and limitations. Ann Otol Rhinol Laryngol. 2010;119:742–8.

    Article  Google Scholar 

  23. Thornell WC. Intralaryngeal approach for arytenoidectomy in bilateral abductor paralysis of the vocal cords. Arch Otolaryngol. 1948;47:505–8.

    Article  CAS  Google Scholar 

  24. Lichtenberger G. Comparison of endoscopic glottis-dilating operations. Eur Arch Otorhinolaryngol. 2003;260:57–61.

    CAS  PubMed  Google Scholar 

  25. Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol. 1989;98:930–4.

    Article  CAS  Google Scholar 

  26. Andrade Filho PA, Rosen CA. Bilateral vocal fold paralysis: an unusual treatment with botulinum toxin. J Voice. 2004;18:254–5.

    Article  Google Scholar 

  27. Benninger MS, Hanick A, Hicks DM. Cricothyroid muscle botulinum toxin injection to improve airway for bilateral recurrent laryngeal nerve paralysis, a case series. J Voice. 2016;30:96–9.

    Article  Google Scholar 

  28. Zealear DL, Swelstad MR, Sant’Anna GD, et al. Determination of the optimal conditions for laryngeal pacing with the Itrel II implantable stimulator. Otolaryngol Head Neck Surg. 2001;125:183–92.

    Article  CAS  Google Scholar 

  29. Li Y, Pearce EC, Mainthia R, et al. Comparison of ventilation and voice outcomes between unilateral laryngeal pacing and unilateral cordotomy for the treatment of bilateral vocal fold paralysis. ORL J Otorhinolaryngol Relat Spec. 2013;75:68–73.

    Article  Google Scholar 

  30. Tucker HM. Long-term results of nerve-muscle pedicle reinnervation for laryngeal paralysis. Ann Otol Rhinol Laryngol. 1989;98:674–6.

    Article  CAS  Google Scholar 

  31. Li M, Chen S, Zheng H, et al. Reinnervation of bilateral posterior cricoarytenoid muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. PLoS One. 2013;8:e77233.

    Article  CAS  Google Scholar 

  32. Bajaj Y, Sethi N, Shayah A, et al. Vocal fold paralysis: role of bilateral transverse cordotomy. J Laryngol Otol. 2009;123:1348–51.

    Article  CAS  Google Scholar 

  33. Dejonckere PH, Obbens C, de Moor GM, Wieneke GH. Perceptual evaluation of dysphonia: reliability and relevance. Folia Phoniatr (Basel). 1993;45:76–83.

    Article  CAS  Google Scholar 

  34. Ma EP, Yiu EM. Multiparametric evaluation of dysphonic severity. J Voice. 2006;20:380–90.

    Article  Google Scholar 

  35. Mehta DD, Hillman RE. Voice assessment: updates on perceptual, acoustic, aerodynamic, and endoscopic imaging methods. Curr Opin Otolaryngol Head Neck Surg. 2008;16:211–5.

    Article  Google Scholar 

  36. Nawka T, Sittel C, Arens C, et al. Voice and respiratory outcomes after permanent transoral surgery of bilateral vocal fold paralysis. Laryngoscope. 2015;125:2749–55.

    Article  Google Scholar 

  37. Benninger MS, Ahuja AS, Gardner G, Grywalski C. Assessing outcomes for dysphonic patients. J Voice. 1998;12:540–50.

    Article  CAS  Google Scholar 

  38. Rosen CA, Lee AS, Osborne J, Zullo T, Murry T. Development and validation of the voice handicap index-10. Laryngoscope. 2004;114:1549–56.

    Article  Google Scholar 

  39. Woo P, Parasher AK, Isseroff T, Richards A, Sivak M. Analysis of laryngoscopic features in patients with unilateral vocal fold paresis. Laryngoscope. 2016;126(8):1831–6.

    Article  Google Scholar 

  40. Woo P, Pearl A, Hsiung M, Som P. Failed medialization laryngoplasty: management by revision surgery. Otolaryngol Head Neck Surg. 2001;124:615–21.

    Article  CAS  Google Scholar 

  41. Grasl MC, Donner A, Schragl E, Aloy A. Tubeless laryngotracheal surgery in infants and children via jet ventilation laryngoscope. Laryngoscope. 1997;107:277–81.

    Article  CAS  Google Scholar 

  42. Rezaie-Majd A, Bigenzahn W, Denk DM, et al. Superimposed high-frequency jet ventilation (SHFJV) for endoscopic laryngotracheal surgery in more than 1500 patients. Br J Anaesth. 2006;96:650–9.

    Article  CAS  Google Scholar 

  43. Kashima HK. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol. 1991;100:717–21.

    Article  CAS  Google Scholar 

  44. Kashima HK. Documentation of upper airway obstruction in unilateral vocal cord paralysis: flow-volume loop studies in 43 subjects. Laryngoscope. 1984;94:923–37.

    Article  CAS  Google Scholar 

  45. Leitersdorfer S, Lichtenberger G, Kovacs I. Assessment of the results of glottis-dilating operations using lung function tests. Eur Arch Otorhinolaryngol. 2002;259:57–9.

    Article  CAS  Google Scholar 

  46. Munin MC, Heman-Ackah YD, Rosen CA, et al. Consensus statement: using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis. Muscle Nerve. 2016;53:850–5.

    Article  Google Scholar 

  47. Sulica L, Blitzer A. Electromyography and the immobile vocal fold. Otolaryngol Clin North Am. 2004;37:59–74.

    Article  Google Scholar 

  48. Meyer TK, Hillel AD. Is laryngeal electromyography useful in the diagnosis and management of vocal fold paresis/paralysis? Laryngoscope. 2011;121:234–5.

    Article  Google Scholar 

  49. Uloza V, Pribuisiene R, Saferis V. Multidimensional assessment of functional outcomes of medialization thyroplasty. Eur Arch Otorhinolaryngol. 2005;262:616–21.

    Article  Google Scholar 

  50. Lichtenberger G, Toohill RJ. Technique of endo-extralaryngeal suture lateralization for bilateral abductor vocal cord paralysis. Laryngoscope. 1997;107:1281–3.

    Article  CAS  Google Scholar 

  51. Lichtenberger G. Reversible lateralization of the paralyzed vocal cord without tracheostomy. Ann Otol Rhinol Laryngol. 2002;111:21–6.

    Article  Google Scholar 

  52. Eliachar I, Zohar S, Golz A, Joachims HZ, Goldsher M. Permanent tracheostomy. Head Neck Surg. 1984;7:99–103.

    Article  CAS  Google Scholar 

  53. Eliachar I, Akst LM, Eliashar R. Unaided speech in tube-free tracheostomy: the supplementary sling procedure. Otolaryngol Head Neck Surg. 2002;127:213–20.

    Article  Google Scholar 

  54. Shapiro MJ, Ramanathan VR. Trachea stoma vent voice prosthesis. Laryngoscope. 1982;92:1126–9.

    CAS  PubMed  Google Scholar 

  55. Montgomery WW. Silicone tracheal cannula. Ann Otol Rhinol Laryngol. 1980;89:521–8.

    Article  CAS  Google Scholar 

  56. Ongkasuwan J, Courey M. The role of botulinum toxin in the management of airway compromise due to bilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg. 2011;19(6):444–8.

    Article  Google Scholar 

  57. Blitzer A, Brin MF, Fahn S, Lange D, Lovelace RE. Botulinum toxin (BOTOX) for the treatment of “spastic dysphonia” as part of a trial of toxin injections for the treatment of other cranial dystonias. Laryngoscope. 1986;96:1300–1.

    Article  CAS  Google Scholar 

  58. Castellanos PF, Gates GA, Esselman G, Song F, Vannier MW, Kuo M. Anatomic considerations in botulinum toxin type A therapy for spasmodic dysphonia. Laryngoscope. 1994;104:656–62.

    Article  CAS  Google Scholar 

  59. Wang CC, Chang MH, De Virgilio A, et al. Laryngeal electromyography and prognosis of unilateral vocal fold paralysis – a long-term prospective study. Laryngoscope. 2015;125:898–903.

    Article  Google Scholar 

  60. Marie JP, Dehesdin D, Ducastelle T, Senant J. Selective reinnervation of the abductor and adductor muscles of the canine larynx after recurrent nerve paralysis. Ann Otol Rhinol Laryngol. 1989;98:530–6.

    Article  CAS  Google Scholar 

  61. Woodman DG, Pennington CL. Bilateral abductor paralysis: 30 years experience with arytenoidectomy. Ann Otol Rhinol Laryngol. 1976;85:437–9.

    Article  CAS  Google Scholar 

  62. Huang YD, Zheng HL, Zhou SM, et al. [Glottic measurement and vocal evaluation after three surgical techniques in the treatment of bilateral vocal cord paralysis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2006;41:648–52.

    Google Scholar 

  63. Nelissen P, White RA. Arytenoid lateralization for management of combined laryngeal paralysis and laryngeal collapse in small dogs. Vet Surg. 2012;41:261–5.

    PubMed  Google Scholar 

  64. Woodson G. Arytenoid abduction for bilateral vocal fold immobility. Curr Opin Otolaryngol Head Neck Surg. 2011;19:428–33.

    Article  Google Scholar 

  65. Ossoff RH, Karlan MS, Sisson GA. Endoscopic laser arytenoidectomy. Lasers Surg Med. 1983;2:293–9.

    Article  CAS  Google Scholar 

  66. Crumley RL. Endoscopic laser medical arytenoidectomy for airway management in bilateral laryngeal paralysis. Ann Otol Rhinol Laryngol. 1993;102:81–4.

    Article  CAS  Google Scholar 

  67. Yilmaz T. Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: a new flap technique and personal experience with 50 cases. Laryngoscope. 2012;122:2219–26.

    Article  Google Scholar 

  68. Linder A, Lindholm CE. Vocal fold lateralization using carbon dioxide laser and fibrin glue. J Laryngol Otol. 1992;106:226–30.

    Article  CAS  Google Scholar 

  69. Dispenza F, Dispenza C, Marchese D, Kulamarva G, Saraniti C. Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury. Am J Otolaryngol. 2012;33:285–8.

    Article  Google Scholar 

  70. Bolzoni Villaret A, Piazza C, Redaelli De Zinis LO, Cattaneo A, Cocco D, Peretti G. Phonosurgery after endoscopic cordectomies. I. Primary intracordal autologous fat injection after transmuscular resection: preliminary results. Eur Arch Otorhinolaryngol. 2007;264:1179–84.

    Article  Google Scholar 

  71. Paniello RC, Edgar JD, Kallogjeri D, Piccirillo JF. Medialization versus reinnervation for unilateral vocal fold paralysis: a multicenter randomized clinical trial. Laryngoscope. 2011;121:2172–9.

    Article  Google Scholar 

  72. Postma GN, Blalock PD, Koufman JA. Bilateral medialization laryngoplasty. Laryngoscope. 1998;108:1429–34.

    Article  CAS  Google Scholar 

  73. Woo P, Pearl AW, Hsiung MW, Som P. Failed medialization laryngoplasty: management by revision surgery. Otolaryngol Head Neck Surg. 2001;124:615–21.

    Article  CAS  Google Scholar 

  74. Paniello RC. Vocal fold paralysis: improved adductor recovery by vincristine blockade of posterior cricoarytenoid. Laryngoscope. 2015;125:655–60.

    Article  CAS  Google Scholar 

  75. Halum SL, Hiatt KK, Naidu M, Sufyan AS, Clapp DW. Optimization of autologous muscle stem cell survival in the denervated hemilarynx. Laryngoscope. 2008;118:1308–12.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA

    Peak Woo

Authors
  1. Peak Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peak Woo .

Editor information

Editors and Affiliations

  1. NYU Swallowing Disorders Center, New York University, New York, NY, USA

    Milan R. Amin

  2. USC Voice Center, University of Southern California, Los Angeles, CA, USA

    Michael M. Johns

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Woo, P. (2019). Decision-Making in Patients with Bilateral Vocal Fold Paralysis with Glottal Insufficiency: Balancing Voice Versus Airway. In: Amin, M., Johns, M. (eds) Decision Making in Vocal Fold Paralysis. Springer, Cham. https://doi.org/10.1007/978-3-030-23475-1_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-23475-1_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23474-4

  • Online ISBN: 978-3-030-23475-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation