Materiały źródłowe

• #1 Vocal cord paralysis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vocal-cord-paralysis/diagnosis-treatment/drc-20378878

  Treatment of vocal cord paralysis depends on the cause, how serious the symptoms are and when symptoms began. Treatment may include voice therapy, bulk injections, surgery or a combination of treatments. […] In some instances, you may get better without surgical treatment. For this reason, your healthcare team may delay permanent surgery for at least a year from the beginning of your vocal cord paralysis. […] However, surgical treatment with various bulk injections is often done within the first three months of voice loss. […] During the waiting period for surgery, you may get voice therapy to help keep you from using your voice improperly while the nerves heal. […] Voice therapy sessions involve exercises or other activities to strengthen your vocal cords and help improve breath control during speech. Voice therapy also can prevent tension in muscles around the paralyzed vocal cord or cords, and protect your airway during swallowing. Voice therapy may be the only treatment needed if the paralysis occurs in an area that doesn’t require additional bulk or repositioning.

• #1 Vocal Cord Paralysis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17624-vocal-cord-paralysis

  Vocal cord paralysis happens when you cant control the muscles that move one or both vocal cords. […] Healthcare providers treat this condition with voice therapy and surgery. […] Treatment depends on the severity of the paralysis and your symptoms. If paralysis is mild, you may need voice therapy to improve how your vocal cords work. During therapy, you do special exercises that strengthen your vocal cords, help you control muscles that help you speak and improve how you breathe when speaking. […] More severe vocal cord paralysis may require surgery. […] With unilateral vocal cord paralysis, providers often choose to delay surgery for up to a year to allow time for the condition to improve. […] Voice therapy administered by a speech-language pathologist with expertise in voice care can sometimes be very effective and help strengthen your voice if the problem is mild/moderate.

• #1 Vocal Fold Paralysis—Symptoms & Treatment | NIDCD

  https://www.nidcd.nih.gov/health/vocal-fold-paralysis

  How is vocal fold paralysis treated? The most common treatments for vocal fold paralysis are voice therapy and surgery. Some people’s voices will naturally recover sometime during the first year after diagnosis, which is why doctors often delay surgery for at least a year. During this time, your doctor will likely refer you to a speech-language pathologist for voice therapy, which may involve exercises to strengthen the vocal folds or improve breath control while speaking. You might also learn how to use your voice differently, for example, by speaking more slowly or opening your mouth wider when you speak. Several surgical procedures are available, depending on whether one or both of your vocal folds are paralyzed. The most common procedures change the position of the vocal fold. These may involve inserting a structural implant or stitches to reposition the laryngeal cartilage and bring the vocal folds closer together. These procedures usually result in a stronger voice. Surgery is followed by additional voice therapy to help fine-tune the voice.

• #1 Vocal Cord Paralysis Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/vocal-cord-paralysis

  Voice therapy sessions involve exercises or other activities to strengthen your vocal cords, improve breath control during speech, prevent abnormal tensions in other muscles around the paralyzed vocal cord, and protect your airway during swallowing. […] If your vocal cord paralysis symptoms don’t fully recover on their own, surgical treatments may be offered to improve your ability to speak and to swallow. Surgical options include: […] Bulk injection. Paralysis of the nerve to your vocal cord will probably leave the vocal cord muscle thin and weak. To add bulk to a paralyzed vocal cord the laryngologist may inject your vocal cord with a substance such as body fat, collagen, or another approved filler. This added bulk brings the affected vocal cord closer to the middle of your voice box so that the opposite functioning and moving vocal cord can make closer contact with the paralyzed cord when you speak, swallow, or cough.

• #1 Vocal Cord Paralysis Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/vocal-cord-paralysis

  Vocal cord paralysis occurs when the nerve impulses to your voice box (larynx) are interrupted. This results in paralysis of your vocal cord muscle. Vocal cord paralysis can affect your ability to speak and even breathe. […] The Mount Sinai Health System in New York City has considerable experience treating vocal cord paralysis. Our Eugen Grabscheid, MD Voice Center offers voice therapy and surgery for vocal cord paralysis. […] Treatment of vocal cord paralysis depends on the cause, the severity of symptoms, and the time from the onset of symptoms. Treatment may include voice therapy, surgery, or both. In some instances, you may get better without surgical treatment. For this reason, your doctor may delay surgery for six months to a year from the beginning of your vocal cord paralysis. During this waiting period, your doctor may suggest voice therapy to help keep you from using your voice improperly while the nerves heal.

• #1 Exercises for Unilateral Vocal Fold Paralysis – Ask the Experts 998

  https://www.speechpathology.com/ask-the-experts/exercises-for-unilateral-vocal-fold-998

  All Licensed Speech Language Pathologists are instructed about various vocal fold disorders in their training as graduate students. […] In terms of exercises, my experiences have differed greatly depending on the patient and their specific presenting symptoms. […] Therefore, it is important to seek an evaluation by a qualified SLP and ENT (ear nose and throat physician) before attempting any of the listed activities. […] Typically as a therapist the goal would be to improve the overall vocal quality, loudness and maintain appropriate pitch for the patient’s age and gender. […] In order to increase loudness it is imperative to improve vocal fold closure and thereby increase the pressure beneath the vocal folds (subglottal pressure). […] Typically, the initial routines are to improve this closure through push/pull and other similar activities that attempt to have the healthy cord move more toward midline and compensate for the immobile cord or to get the immobile cord moving again.

• #1 Exercises for Unilateral Vocal Fold Paralysis – Ask the Experts 998

  https://www.speechpathology.com/ask-the-experts/exercises-for-unilateral-vocal-fold-998

  There are also surgical procedures that will physically move the affected cord to midline (medialization techniques) to allow the „healthy” cord to not have to move as far over to get to midline in order to contact the immobile cord. […] However, this is usually discussed after therapy has not improved the condition. […] Other exercises that seem to create this balance are starting with a gentle massage of the laryngeal musculature through manual circumlaryngeal massage (Aronson Technique). […] Also the Lee Silverman Voice Treatment Program (Developed by Lori Ramig) has been used to improve loudness in VFP cases. […] Essentially by attempting to speak louder you are moving the vocal folds closer together thus there is the increased possibility of improved closure and thus increased loudness levels.

• #1 Exercises for Unilateral Vocal Fold Paralysis – Ask the Experts 998

  https://www.speechpathology.com/ask-the-experts/exercises-for-unilateral-vocal-fold-998

  Another technique is digital manipulation of the larynx. […] Other elements of successful therapies include improving overall patient awareness of respiratory support of voice, appropriate hygiene and vocal care (water intake, etc), vocal fold and upper airway anatomy. […] Progress in therapy should also be monitored constantly and manipulated to suit the patient’s goals in therapy.

• #1 Unilateral Vocal Fold Paralysis Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/863779-treatment

  Studies suggest a robust patient response to nimodipine in acute UVFP, with recovery of nerve function. […] It is recommended that nimodipine therapy begin any time prior to 4 months after the date of new vocal fold immobility from any cause. […] Voice therapy can play a role in the treatment of unilateral vocal fold paralysis (UVFP). […] In the setting of vocal fold paralysis, voice therapy is generally not a long-term treatment modality; substantive results are usually obtained in 2-3 sessions. […] The most commonly used voice therapy techniques for UVFP include vocal hygiene and modification of voice use and the voice use environment. […] A retrospective study by Kurz et al indicated that in the treatment of early UVFP, selective electrical stimulation (SES) of the larynx produces functional improvement comparable to that obtained through voice therapy.

• #1 Vocal cord paralysis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vocal-cord-paralysis/diagnosis-treatment/drc-20378878

  Vocal cord repositioning. In this procedure, a surgeon moves a window of your own tissue from the outside of your voice box inward, pushing the paralyzed vocal cord toward the middle of your voice box. This allows your functioning vocal cord to better vibrate against the paralyzed vocal cord. […] Replacing the damaged nerve, known as reinnervation. In this surgery, a healthy nerve is moved from a different area of the neck to replace the damaged vocal cord. It can take as long as 6 to 9 months before your voice gets better. This surgery is sometimes combined with a bulk injection. […] Tracheotomy. If both of your vocal cords are paralyzed and positioned closely together, your airflow will be decreased. This causes a lot of trouble breathing and requires a surgery called a tracheotomy. […] Linking the vocal cords to another source of electrical stimulation may restore opening and closing of the vocal cords that can’t move. Other sources of electrical stimulation might be a nerve from another part of the body or a device similar to a cardiac pacemaker. Researchers continue to study this and other options.

• #1 Vocal cord paralysis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vocal-cord-paralysis/diagnosis-treatment/drc-20378878

  If your vocal cord paralysis symptoms don’t fully recover on their own, you may need surgery to improve your ability to speak and to swallow. […] Surgical options include: […] Bulk injection. Paralysis of the nerve to your vocal cord will probably leave the vocal cord muscle thin and weak. A doctor who specializes in disorders of the larynx, known as a laryngologist, may add bulk to the paralyzed vocal cord. This is done by injecting the vocal cord with a substance such as body fat, collagen or another approved filler substance. This added bulk brings the affected vocal cord closer to the middle of the voice box. Then the functioning vocal cord can make closer contact with the paralyzed cord when you speak, swallow or cough. […] Structural implants. This procedure relies on the use of an implant in the larynx to reposition the vocal cord. The procedure also is known as thyroplasty, medialization laryngoplasty or laryngeal framework surgery. Rarely, people who have this surgery may need to have a second surgery to reposition the implant.

• #1

  https://umiamihealth.org/en/treatments-and-services/ear,-nose,-and-throat-(ent)/laryngology-and-voice/vocal-cord-paralysis

  Vocal Fold Injections: Our team has been treating patients with vocal fold paralysis for the past 10 years with an in-office procedure that takes less than 15 minutes. Under local anesthetic, an inert filler material is injected through a fine needle to bulk up and push over the paralyzed vocal fold. This allows the mobile vocal fold to meet the paralyzed one more easily and with much less effort when speaking. Patient tolerance is good with only mild discomfort. Results are usually instantaneous and, depending on which material is injected, last anywhere from 2-3 months to 1 year. Over time, the material is generally reabsorbed, but many patients can experience longer lasting improvement. […] Surgery: If your vocal cord paralysis does not resolve on its own or with therapy, your ENT specialist may recommend surgery. Your ENT surgeon places structural implants to help reposition your vocal cords. […] Emerging Treatments: An ENT specialist may recommend an emerging treatment for your vocal cord paralysis. Speak with your doctor for more information about the options that may be available to you.

• #1 Vocal Cord Paralysis Program

  https://www.massgeneral.org/surgery/voice-center/treatments-and-services/vocal-cord-paralysis

  Physicians at Massachusetts General Hospitals Voice Center treat vocal cord paralysis with expertise and pioneering techniques. […] For patients with unilateral vocal cord paralysis, surgery to reposition the paralyzed vocal cord as opposed to a vocal cord injection is the most precise way to achieve a permanently better voice. In a medialization laryngoplasty, we place an inert, non-absorbable medical-grade implant to push the paralyzed vocal cord into better position for speaking. […] Depending on the severity of the unilateral vocal cord paralysis, some patients require special additional surgeries (adduction arytenopexy and/or cricothyroid subluxation) that were developed by the laryngeal surgeons at the Massachusetts General Hospital Voice Center. […] In the case of unilateral (one-sided) vocal cord paralysis, the vocal cord gap that results during speech can usually be reduced by pushing the non-moving vocal cord towards the middle with an injection into it. […] Many ENT physicians only perform vocal cord injections in the operating room, under general anesthesia. At the Voice Center, we routinely inject an immobile vocal cord in the office in a matter of minutes, using only topical anesthesia while the patient is wide awake.

• #1 Vocal Cord (Fold) Paralysis – ENT Health

  https://www.enthealth.org/conditions/vocal-cord-fold-paralysis/

  Laryngeal framework surgery (also called medialization laryngoplasty) Your surgeon will make a small incision in your neck and insert an implant into your voice box to move your vocal cord toward the middle, helping both cords close and vibrate better. Commonly used implants include silastic blocks (silastic is a form of silicone gel) or Gore-Tex sheets. This procedure is often done under local anesthesia in the operating room, and the results are typically permanent. […] If you suffer from vocal cord paralysis, your doctor will be able to guide you and find the best treatment options for your symptoms and needs.

• #1

  https://med.uth.edu/orl/2020/01/10/vocal-cord-fold-paralysis/

  Laryngeal framework surgery (also called medialization laryngoplasty) Your surgeon will make a small incision in your neck and insert an implant into your voice box to move your vocal cord toward the middle, helping both cords close and vibrate better. Commonly used implants include silastic blocks (silastic is a form of silicone gel) or Gore-Tex sheets. This procedure is often done under local anesthesia in the operating room, and the results are typically permanent. […] If you suffer from vocal cord paralysis, your doctor will be able to guide you and find the best treatment options for your symptoms and needs.

• #1 Vocal Cord Paralysis Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/vocal-cord-paralysis

  Vocal cord repositioning. In this procedure, a surgeon moves a window of your own tissue from the outside of your voice box inward, pushing the paralyzed vocal cord toward the middle of your voice box. This allows your unimpaired vocal cord to better vibrate against its paralyzed partner. […] Tracheotomy. If both of your vocal cords are paralyzed and positioned closely together, your airflow will be decreased. In this situation, you’ll have a lot of trouble breathing and require a surgical procedure called a tracheotomy. In a tracheotomy, an incision is made in the front of your neck and an opening created directly into the wind pipe (trachea). A breathing tube is inserted, allowing air to bypass the immobilized vocal cords.

• #1 Vocal Cord Paralysis | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/vocal-cord-paralysis/

  Arytenoid adduction: Surgery to position the paralyzed vocal cord joint closer to the functioning vocal cord to improve speech, breathing, and swallowing. […] Laryngeal reinnervation surgery: Procedure to connect a damaged nerve to a functioning nerve to improve nerve signals that control vocal cord muscles.

• #1 Unilateral Vocal Fold Paralysis Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/863779-treatment

  Permanent vocal fold surgical treatment can be divided into vocal fold injection and laryngeal framework surgery. […] Surgical treatment of the arytenoid cartilage for UVFP is important to restore optimal length/tension of the paralyzed vocal fold and to medialize the posterior glottis. […] Combined surgical treatment of UVFP with both an adduction procedure involving the arytenoid cartilage and medialization laryngoplasty has been found to yield maximal vocal rehabilitation by many leading surgeons. […] Expected voice outcome following the treatment for unilateral vocal fold paralysis (UVFP) is excellent. […] Studies of the drug nimodipine in the setting of acute vocal fold immobility have shown promise in the recovery of actual vocal fold motion. […] The future goal of laryngology research is to create a method of dynamic rehabilitation of the paralyzed vocal fold.

• #1 Vocal Cord Paralysis | Durham, Raleigh, North Carolina | Duke Health

  https://www.dukehealth.org/treatments/voice-disorders/vocal-cord-paralysis

  An implant (like a tiny shim) is placed through the outside of the voice box to reposition the paralyzed vocal cord and produce a stronger voice. This procedure requires a small incision in the neck and is performed in an operating room under sedation. Thyroplasty may be recommended if your vocal cord paralysis appears permanent and your voice is weak and breathy. […] This procedure is sometimes used in combination with thyroplasty. It corrects the position of the vocal cord to achieve better vocal cord closure and a stronger voice. […] This surgical procedure connects a nerve to the weakened vocal cord muscle. It is performed in the operating room under general anesthesia. This restores the vocal cord’s tone and bulk, which makes the voice stronger. Full results can take two to six months.

• #1 Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5545703/

  Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. The primary objective of intervention for BVFP is to relieve patients dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP.

• #1 :: Clinical and Experimental Otorhinolaryngology

  https://www.e-ceo.org/m/journal/view.php?number=543

  Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. […] The primary objective of intervention for BVFP is to relieve patients dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. […] More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. […] Tracheostomy remains the most commonly used procedure in the early onset period when nerve recovery is still hopeful. […] Various surgical procedures have been developed to address the airway restriction seen with BVFP. […] Arytenoidectomy is widely used either alone or in combination with partial resection of the vocal fold (i.e., arytenoid cordectomy). […] Like arytenoidectomy, cordotomy (i.e., posterior cordotomy and transverse cordotomy) is another irreversible surgical approach that aims at enlargement of the airway aperture at the glottic level by excision of tissues.

• #1 Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5545703/

  The primary objective of intervention for BVFP is to improve patients ventilation. Various surgical procedures have been developed to address the airway restriction seen with BVFP. Tracheostomy remains the most commonly used procedure in the early onset period when nerve recovery is still hopeful. […] In addition, new techniques such as laryngeal pacing and reinnervation procedures have also been studied and applied in some cases of BVFP. […] Other treatment approaches currently being investigated include gene therapy and stem cell therapy. […] Laterofixation can be performed independently or coupled with other endoscopic procedures, such as arytenoidectomy. […] In summary, laryngeal reinnervation appeared to be a promising surgical approach for BVFP patients. However, the evidence of success in humans is limited, thus more clinical trials are needed before any other conclusion may be drawn.

• #1 Vocal Fold Paralysis—Symptoms & Treatment | NIDCD

  https://www.nidcd.nih.gov/health/vocal-fold-paralysis

  When both vocal folds are paralyzed, a tracheotomy may be required to help breathing. In a tracheotomy, an incision is made in the front of the neck and a breathing tube is inserted through an opening, called a stoma, into the trachea. Rather than occurring through the nose and mouth, breathing now happens through the tube. Following surgery, therapy with a speech-language pathologist helps you learn how to use the voice and how to properly care for the breathing tube.

• #1 :: Clinical and Experimental Otorhinolaryngology

  https://www.e-ceo.org/m/journal/view.php?number=543

  Botox may be used to block aberrant reinnervation of the adductor muscles by inspiratory motoneurons. […] Gene therapy for BVFP presents the idea of delivering genes to the injured neurons and/or denervated muscles, thus enhancing the regrowth of these damaged neurons and rejuvenating laryngeal muscles. […] Stem cell transplantation has been recognized as a therapy by allowing tissue regeneration. […] The treatment options for BVFP are summarized in Table 1. Static glottis enlarging procedures, which function by either resection of laryngeal tissues (i.e., arytenoidectomy and cordotomy) or displacing anatomical structures (i.e., suture laterofixation of vocal fold or arytenoid abduction), are most commonly used as they provide an immediate effect of airway improvement regardless of the innervation status of laryngeal muscles. […] Other new techniques, such as reinnervation, laryngeal pacing and Botox injection, are still experimental.

• #1 :: Clinical and Experimental Otorhinolaryngology

  https://www.e-ceo.org/m/journal/view.php?number=543

  Laterofixation (i.e., suture laterofixation and suture lateralization) of the arytenoid and/or the attached vocal fold using a combination of endoscopic and external means has emerged as an alternative surgical approach for BVFP. […] In fact, the primary goal should be to re-establish the vocal fold abduction through reinnervation of the abductor (PCA) muscle, as dyspnea is the major symptom in most of these patients whose adducting function is partially preserved. […] The most explored and applied reinnervation procedure is transplanting an active nerve-muscle pedicle to the PCA muscle harvested from an accessory muscle of inspiration (i.e., omohyoid or sternohyoid). […] Functional electrical stimulation (FES) of paralyzed laryngeal muscles has been investigated over the last 4 decades.

• #1 Bilateral Vocal Fold Paralysis Treatment & Management: Medical Therapy, Surgical Therapy, Intraoperative Details

  https://emedicine.medscape.com/article/863885-treatment

  The goal of all the described procedures is to restore a glottic airway despite compromised abductor and adductor function. […] A literature review by Lechien et al reported that in patients with bilateral vocal fold (cord) paralysis (BVFP), both unilateral and bilateral posterior transverse cordotomy led to a 95.1% decannulation rate and adequate airway volume. […] Several techniques and approaches for the restoration of glottic competence in patients with bilateral vocal fold (cord) immobility (BVFI) are experimental but are promising. They include PCA muscle reinnervation, electrical stimulation of the laryngeal muscles, and use of the Cummings mechanical device. […] In a study of nine symptomatic persons with BVFP who underwent unilateral implantation of a laryngeal pacemaker, Mueller et al found that neurostimulation produced an immediate and stable improvement in peak expiratory flow.

• #1 Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5545703/

  In summary, these animal trials and pioneer clinical cases demonstrated clearly the feasibility of FES in the treatment BVFP. Future studies may involve a multicenter clinical trial of laryngeal pacing. […] Overall, Botox injection appeared to provide an acceptable, but temporary (around 3 months) improvement in glottal opening. […] The emergence of gene therapy and stem cell therapy reflects new ideas in treatment for BVFP by promoting regrowth of neurons and atrophic muscles. However, both techniques are limited by their null effect in preventing synkinesis. Further study in both animals and humans will be needed to explore their potential benefits for BVFP.

• #1 Vocal cord paresis – Wikipedia

  https://en.wikipedia.org/wiki/Vocal_cord_paresis

  After 9 months of observation, should the paralysis not resolve and the patient be dissatisfied with the outcomes of voice therapy, the next option is temporary injection medialization. In this procedure, a variety of materials can be injected into the body of the vocal fold in order to bring it closer to the midline of the glottis. […] For patients with significant paralysis at 12 months post-onset, medialization thyroplasty may be suggested. This surgical procedure introduces a shim between the inner wall of the larynx and the soft tissue supporting the vocal fold. […] In addition to medialization thyroplasty, arytenoid adduction can be performed to improve phonation results. […] A further surgical intervention used to mitigate vocal fold paresis is laryngeal reinnervation. This procedure restores nerve supply to the larynx and can be accomplished according to different techniques. […] It is generally recommended that voice therapy start 1 to 2 months after surgery, when swelling has subsided. Post-surgical intervention is warranted to restore laryngeal muscle strength, agility and coordination.

• #1 Vocal Fold Paralysis | University of Utah Health

  https://healthcare.utah.edu/ent/specialties/voice-disorders-center/types/vocal-fold-paralysis

  Reinnervation […] Vocal fold surgeries typically include at least one night in the hospital after surgery. You typically are able to eat soft foods, drink, and gently use your voice after surgery. Avoid heavy lifting for at least two weeks after the procedure. Full recovery usually takes at least six weeks. […] The success of vocal fold surgery depends on the underlying cause of vocal fold paralysis. Your surgeon will help you understand what results you can expect after surgery for your individual case.

• #1 Vocal Cord Paralysis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17624-vocal-cord-paralysis

  A laryngologist may recommend surgery or a vocal fold injection to help improve voice, swallowing and breathing problems. […] People with two paralyzed vocal cords can have a dangerously narrow airway. Theyll often need a tracheostomy (tracheotomy or trach) to open their airway and help with breathing. […] Sometimes, the vocal cords repair themselves. This may take months. With voice therapy, vocal cord injections or implants, your voice may get stronger and allow people to hear you better when you talk. […] Talk to your healthcare provider if you have a condition that increases your risk. They may recommend regular checkups to test your vocal cords. You may need voice therapy to improve how your vocal cords work. […] Many cases of vocal cord paralysis can improve by themselves with time. Voice therapy and sometimes filler injections can help make your symptoms better while waiting for your vocal cords to recover. […] With treatment, many people regain the ability to talk and swallow after vocal cord paralysis.

• #1 Common Questions about Vocal Fold Paralysis – Department of Surgery

  https://www.surgery.wisc.edu/2019/04/19/common-questions-about-vocal-fold-paralysis/

  Learn about diagnosis, treatment, and research of vocal fold paralysis. […] Many treatments exist, including voice and swallow therapy, injection augmentation, and more permanent operations (e.g., framework surgery, reinnervation, arytenoid procedures). […] Decisions about treatment depend on time since injury, the severity of symptoms, and how it is affecting the affected persons quality of life. […] Early injection augmentation improves voice quality and reduces effort needed to voice. […] These operations are considered permanent fixes for the unilateral vocal fold paralysis; thus, we tend to wait between 6 to 12 months before we recommend them. […] In some cases, if the paralyzed vocal fold is in an ideal (near-median) position and the patient has mild-to-no perceptual dysphonia and primary issues with endurance and fatigue, voice therapy techniques can be highly effective and medialization may not be needed. […] In most other cases, voice therapy is indicated as an adjunct to surgical medialization to assist with adjustments in phonatory technique and to manage maladaptive voicing behaviors that may have developed to compensate for glottal incompetence.

• #1 Vocal Cord Paralysis | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/vocal-cord-paralysis

  Injecting a filler material into the affected vocal cord (injection laryngoplasty) […] Restoring function to the nerve for the vocal cord with the recurrent laryngeal nerve (ANSA-RLN) reinnervation procedure. […] Alternative approaches may be needed if your child is aspirating fluid into the lungs. Our speech pathologist will ensure that your child is safe from a feeding standpoint, and may recommend one of the following approaches if there is aspiration: […] For children closer to 3 years of age, the reinnervation procedure and injection laryngoplasty can be used for managing aspiration if the issue has not resolved. […] For those children who undergo a reinnervation procedure, the outlook is excellent. […] Some children with vocal cord paralysis will not have any related voice or swallowing issues and will have normal quality of life without treatment. However, in other children who do not undergo treatment for vocal cord paralysis, there is a significant impact on the ability to communicate: It may be hard to hear your child speak or to understand her due to a raspy or breathy-sounding voice. […] If a surgical intervention is recommended, your child will be seen about one to two months after surgery, and then every three to six months after surgery until the voice normalizes (about 18-20 months after a reinnervation procedure).

• #1

  https://link.springer.com/article/10.1007/s40136-020-00320-8

  While static procedures are successful approaches to managing the airway and ultimately can help with decannulation in patients with BVFMI, these procedures often result in worsening phonation and increased aspiration. In contrast, laryngeal reinnervation provides an alternative approach with the goal of improving both abduction and adduction of the bilateral vocal folds. […] Given the previous success with implantable devices such as cardiac pacemakers, cochlear implants, and even hypoglossal nerve stimulators, recent studies have investigated the use of implantable devices in laryngeal pacing for treatment of BVFMI. […] Treatment should be tailored according to each patient but also to the experience of the otorhinolaryngologist. As patients may experience spontaneous recovery, a trial of conservative treatment can be planned initially. When conservative measures fail, static procedures that are less vocally impairing or chemodenervation procedures can be tried. Additionally, some patients might require multiple procedures. Dynamic interventions provide promising alternatives to tracheostomy and static procedure. At this time, laryngeal reinnervation (in children and adults) and laryngeal pacing (in adults) provide excellent alternatives to more traditional techniques.

• #1 Speaking Clearer: Updates on Vocal Cord Paralysis Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/podcasts/head-and-neck-innovations/speaking-clearer-updates-on-vocal-cord-paralysis-treatment

  So here at the Cleveland Clinic and at tertiary centers who do a lot of this, we work very closely with our speech and language pathology colleagues. […] The biggest take home point, both within otolaryngology and outside, is to send dysphonia to people who specifically treat it and I think most people do very well with that approach.

• #1

  https://link.springer.com/article/10.1007/s40136-020-00320-8

  Management of BVFMI requires a multidisciplinary approach including intensivists, skilled otolaryngologists, and speech-language pathologists. The primary treatment is to provide a safe airway that does not compromise the patients life. The main decision is the need for tracheotomy. […] Improvements in neonatal care, the assessment and monitoring of apnea, and use of nasal CPAP or high-flow air by nasal cannula may be helpful in decreasing the need for tracheotomies in children. […] Many centers believe that after 1 year, a chance for spontaneous recovery is low, and a procedure that can help decannulation should be offered. […] Patients that cannot be decannulated and who do not have spontaneous resolution of VFP have several options to have an improved airway patency. These options are divided into static, chemical, and dynamic approaches.

• #2 Vocal Cord Paralysis Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/vocal-cord-paralysis

  Vocal cord paralysis occurs when the nerve impulses to your voice box (larynx) are interrupted. This results in paralysis of your vocal cord muscle. Vocal cord paralysis can affect your ability to speak and even breathe. […] The Mount Sinai Health System in New York City has considerable experience treating vocal cord paralysis. Our Eugen Grabscheid, MD Voice Center offers voice therapy and surgery for vocal cord paralysis. […] Treatment of vocal cord paralysis depends on the cause, the severity of symptoms, and the time from the onset of symptoms. Treatment may include voice therapy, surgery, or both. In some instances, you may get better without surgical treatment. For this reason, your doctor may delay surgery for six months to a year from the beginning of your vocal cord paralysis. During this waiting period, your doctor may suggest voice therapy to help keep you from using your voice improperly while the nerves heal.

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