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Early Management of Unilateral Vocal Fold Paralysis

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Decision Making in Vocal Fold Paralysis

Abstract

Early management of unilateral vocal fold paralysis (UVFP) includes behavioral, medical, and surgical interventions in the first 6 months after the onset of paralysis. There is no universal algorithm for the early management of UVFP. The patient’s symptoms and expectations shape treatment choices. The most common, and very effective, treatment employed during acute management of glottal incompetence from UVFP is temporary injection laryngoplasty. Although patients often most appreciate the voice quality improvement after vocal fold augmentation, the improved swallowing function and cough effectiveness are most important. In patients who have minimal or no symptomatic repercussions from their UVFP, observation is a reasonable option. Early treatment of UVFP is driven by the patient’s symptoms (swallowing difficulties, voice requirements), underlying medical comorbidities, and their own desires for treatment. Understanding and discussing the expected natural evolution of UVFP is critical in the decision-making process. We are at the dawn of developing new treatments to restore dynamic vocal fold motion by manipulating the microenvironment surrounding injured nerves. Although these treatments are in their infancy, the concept of advancing treatment of UVFP beyond traditional static treatments is exciting.

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Abbreviations

FEES:

Fiberoptic endoscopic evaluation of swallowing

LEMG:

Laryngeal electromyography

MBS:

Modified barium swallow

RLN:

Recurrent laryngeal nerve

SLP:

Superficial layer of the lamina propria

UVFP:

Unilateral vocal fold paralysis

VFI:

Vocal fold injection

VFP:

Vocal fold paralysis

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Author information

Authors and Affiliations

  1. Department of Otolaryngology and Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA

    Andrée-Anne Leclerc

  2. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Libby J. Smith

Authors
  1. Andrée-Anne Leclerc
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  2. Libby J. Smith
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Corresponding author

Correspondence to Libby J. Smith .

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

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Leclerc, AA., Smith, L.J. (2019). Early Management of Unilateral Vocal Fold Paralysis. In: Amin, M., Johns, M. (eds) Decision Making in Vocal Fold Paralysis. Springer, Cham. https://doi.org/10.1007/978-3-030-23475-1_3

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  • DOI: https://doi.org/10.1007/978-3-030-23475-1_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23474-4

  • Online ISBN: 978-3-030-23475-1

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