UNILATERAL VOCAL FOLD PARALYSIS: CAUSES, OPTIONS AND OUTCOMES

TLDR

Vocal fold paralysis has diverse aetiologies and requires individualized management strategies. The authors reviewed 108 unilateral cases, classifying causes and treatment approaches—including observation, speech therapy, and surgical options such as augmentation, thyroplasty, and re‑innervation. About 72 % of patients achieved near‑normal voice, with early intervention proving safe and effective, particularly autologous fat augmentation yielding sustained improvement.

Abstract

Background : This study presents the current aetiology of and management options for vocal fold paralysis. Methods : One hundred and eight patients with unilateral vocal fold paralysis, managed by The Sydney Voice Clinic from 1989 to 1996, are reviewed. Aetiology of the palsy was classified as iatrogenic (45 of 108), idiopathic (36 of 108) and other defined causes (27 of 108). Nineteen patients were observed with the rest being managed with speech therapy alone (38 of 108), surgery (24 of 108) or surgery with adjuvant speech therapy (27 of 108). Surgical techniques included vocal fold augmentation ( n = 43), thyroplasty ( n = 20) and laryngeal re‐innervation ( n = 12). Results : Overall 78 of 108 patients had restoration of near normal to normal voice with an additional 14 attaining a very good voice or better (voice outcome < 2). Conclusions : Early intervention for symptomatic patients was found to be rewarding and safe. Vocal fold augmentation with autologous fat was particularly successful in achieving sustained improvement of voice.