Timing of Intervention for Unilateral Vocal Fold Paralysis

Abstract

Patients with new onset unilateral vocal fold paralysis are often told to wait 12 months for spontaneous recovery. This wait-and-see approach is outdated in the age of in-office vocal fold injections, readily available short-acting injectable materials, and new data on the natural time course of recoverable vocal fold paralysis. This chapter incorporates up-to-date clinical and research evidence to update the traditional 12-month rule. A triad of factors in deciding the timing of intervention are discussed: the functional status of the patient, the prognosis of eventual recovery, and the time from the onset of vocal symptom. In addition, a presumed causal effect of early vocal fold injection augmentation on improving the final functional outcome is critically examined. The goal of the chapter is to impart the reader with the necessary tools and knowledge to conduct an informed discussion with the patient with unilateral vocal fold paralysis in shared decision-making on the timing of temporary or permanent intervention.