The patient had “clear left vocal fold paralysis,” with some volume loss or atrophy on the left side, Dr. Johns said after watching footage. “This is a patient who has potentially recoverable vocal fold paralysis, provided the nerve was left intact.” But, he added, “I’m not sure it’s going to change the management acutely.” Dr. Blumin agreed, saying it would only matter if the original surgeon actually said the nerve had been severed, in which case you would know recovery is less likely to occur spontaneously. Dr. Simpson added, “If it’s benign disease, they’ll very rarely say they think they cut the nerve or even injured the nerve.”
Dr. Blumin said he wouldn’t be likely to order EMG because it wouldn’t change the management: “She’s still four months [out] so there’s still a potential for spontaneous recovery.”
Dr. Johns said he used to do more diagnostic EMGs in cases like this, but he does fewer now. “It’s not a perfect test,” he said. Within the first two or three months of paralysis, an EMG wouldn’t change management, he added, and after about six months, recovery is not likely anyway. It’s that in-between period where an EMG may be valuable. “There’s that sweet spot in the two- to six-month period where maybe if there were unfavorable prognostic signs on a laryngeal EMG, we might consider early intervention with laryngeal framework surgery,” he said. But he said he’s stopped doing that—for the most part, anyway—because of recent studies showing that using a temporary injectable material leads to durable voice results in two-thirds of patients, regardless of recovery status.
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