Time course of recovery of idiopathic vocal fold paralysis

Abstract

Objectives/Hypothesis: To clarify the time course of recovery in patients with idiopathic vocal fold paralysis. Study Design: Retrospective chart review. Methods: Medical records for all patients with idiopathic vocal fold paralysis over a 10-year period were reviewed to obtain demographic and clinical information, including onset of disease and recovery of vocal function. Stroboscopic exams of patients who recovered voice were reviewed blindly to assess return of vocal fold motion.Results: Thirty-eight of 55 patients (69%) recovered vocal function. Time course of recovery could be assessed in 34 patients who did not undergo injection augmentation. The mean time to recovery was 152.8 6 109.3 days (left, 179.8 6 111.3 days; right, 105.3 6 93.7 days; P 5.088). Two-thirds of patients recovered within 6 months. Probability of recovery declined over time. Five of 22 patients who recovered voice had return of vocal fold motion; 17 did not. The mean time to recovery did not differ between these groups (return of motion, 127.4 6 132.3 days; no return of motion, 160.1 6 105.1 days; P 5.290).Conclusions: Sixty-nine percent of patients with idiopathic vocal fold paralysis recovered vocal function, two-thirds doing so within 6 months of onset. Age, gender, laterality, use of injection augmentation did not influence recovery rate. Declining probability of recovery over time leads us to consider framework surgery after 6 months in patients with idiopathic paralysis.

Time Course of Recovery of Iatrogenic Vocal Fold Paralysis

“…Because aggregate recovery rates do not account for the “age”—or time from onset—of the vocal fold paralysis; they consistently overstate probability of recovery and are thus less precise guides to treatment selection. In contrast to patients with idiopathic VFP, however, these data have not led us to recommend framework surgery to patients with iatrogenic VFP earlier than we have in the past because the recovery appears to occur more evenly over time, with significant potential for recovery retained later in the course of the condition.…”

“…16 A previous study yielded a curve illustrating the recovery of idiopathic VFP over time. 3 A similar curve of iatrogenic VFP recovery was derived from the date in the current study and compared to the idiopathic VFP recovery curve (Fig. 5).…”

“…A prior study described the time course of recovery in patients with idiopathic VFP. 3 In this study, we aim 1) to describe the time course of recovery of voice as well as vocal fold movement in patients with iatrogenic VFP, 2) to evaluate the effect of side and site of injury, and 3) to use this information to generate treatment recommendations. We also seek to compare recovery of voice and movement in iatrogenic and idiopathic VFP, which may differ as a result of differences in pathophysiology.…”

Vocal motor control and central auditory impairments in unilateral vocal fold paralysis

“…Inclusion criteria for subjects with UVFP were age between 20 and 80 years, English‐speaker, clinically confirmed paralysis > 12 months (mean in days (standard deviation [SD], range)) = 707 (364, 399–1209) or known intraoperative transection of the recurrent laryngeal nerve, and treatment with type I thyroplasty > 3 months (mean in days (SD, range)) = 887 (562, 125–1850) before study participation. All treated UVFP subjects had documented satisfactory surgical outcomes as evidenced by complete glottal closure on postoperative videolaryngostroboscopy . Exclusion criteria were high vagal nerve injury, prior laryngeal trauma, history of laryngeal cancer or radiation, and unwillingness or contraindication to undergo neuroimaging studies.…”

“…All treated UVFP subjects had documented satisfactory surgical outcomes as evidenced by complete glottal closure on postoperative videolaryngostroboscopy. [14][15][16][17] Exclusion criteria were high vagal nerve injury, prior laryngeal trauma, history of laryngeal cancer or radiation, and unwillingness or contraindication to undergo neuroimaging studies. All participants gave written informed consent.…”