Voice Outcomes in Chronic Unilateral Vocal Fold Paralysis: A Comparative Study of Interventional Approaches.

OBJECTIVES

Managing chronic unilateral vocal fold paralysis (UVFP) typically involves a combination of voice rehabilitation and surgical interventions, such as injection laryngoplasty (IL), laryngeal framework surgery, and laryngeal reinnervation. Assessing treatment impact on voice quality is crucial to determine the effectiveness and guide further interventions. This study aimed to assess objective and subjective vocal outcomes associated with various interventional approaches in patients with chronic UVFP.

METHODS

This retrospective study included 90 patients with UVFP treated at Hospital Universitario La Paz between 2010 and 2024. Patients who experienced recovery of vocal fold mobility or had less than 1 year of follow-up after the onset of paralysis were excluded. Patients were grouped based on the therapeutic approach: group 1 (isolated voice therapy [VT]), n = 26; group 2A (IL), n = 16; group 2B (IL followed by medialization thyroplasty [MT]), n = 12; group 3 (MT), n = 36. Voice quality was evaluated at baseline and postintervention: at the end of VT; 3 months after IL; and 1 year after MT. Vocal parameters measured included the Voice Handicap Index-10 (VHI-10), GRBAS (grade, roughness, breathiness, asthenia, strain) scale, maximum phonation time (MPT), and maximal intensity.

RESULTS

Significant improvements were observed across all groups in VHI-10 scores, overall severity of dysphonia, and MPT postintervention. The MT group demonstrated the greatest degree of improvement in the overall severity of dysphonia and MPT. However, final vocal outcomes were comparable across all groups, with no statistically significant differences in VHI-10 (P = 0.157), severity of dysphonia (P = 0.258), MPT (P = 0.109), or maximal intensity (P = 0.853).

CONCLUSION

While MT resulted in the greatest improvement in overall severity of dysphonia and MPT, all treatment modalities effectively improved voice quality. Ultimately, these interventions achieved comparable final vocal outcomes, highlighting the importance of individualized treatment strategies for patients with UVFP.