The Natural History of Vocal Fold Motion Recovery in Unilateral Vocal Fold Paralysis.

OBJECTIVES

Voice recovery in unilateral vocal fold paralysis (UVFP) has been shown to follow a two-phase time course, with an "early" group consistent with low-grade neuronal injuries and a "late" group with more severe injuries. The aims of this study were to (1) determine if VF motion recovery also follows a two-phase model, and (2) determine if early motion recovery portends a higher likelihood of greater return of motion.

METHODS

UVFP patients over a 16-year period were included in this retrospective study. Laryngoscopies from each visit were reviewed to determine the degree of motion recovery. Time from the onset of paralysis to motion or voice recovery was collected. The time to recovery data were fit to a previously described two-phase model incorporating an exponentially modified Gaussian. Time courses of voice and various degrees of motion recovery were compared using Kaplan-Meier estimates.

RESULTS

23.7% (213/899) patients recovered some degree of VF motion, with 16.8% (156/931) experiencing spontaneous voice recovery. VF motion recovery followed a two-phase model for peripheral, non-idiopathic etiologies. Trace motion occurs approximately 1 month following voice recovery, with further motion occurring 2 months following voice recovery. Patients who recovered VF motion early in their clinical course (< 120 days) were more likely to develop greater degrees of motion recovery (p < 0.001).

CONCLUSION

Return of VF motion appears to be possible in some cases with higher grade neuronal injuries. Recovery of voice, return of trace VF motion, and return of greater degrees of motion appear to be temporally sequenced.