Dr. Merati agreed. “An EMG may be helpful,” he said, “but just the act of relatively early injection laryngoplasty or medialization may reduce the rate of requiring permanent medialization later. I think that’s been a big change, particularly over the last couple years. I wonder if we’re all just sensitive now, just seeing the papers.” (Laryngoscope. 2010;120(11):2237-2240; Laryngoscope. 2012;122(10):2227-2233).
Dr. Johns said he would order a detailed voice assessment because that would be key in deciding whether to intervene at all. Dr. Simpson added: “I think it matters a lot what they do for a living,” and he’s more likely to intervene with a patient whose job involves using his voice a lot. He also cautioned against focusing too much on one vocal fold, because there could be subtle paresis on the other side, too. “That’s a mistake that I continue to learn from,” he said.
Dr. Blumin said that if the patient wanted treatment, he would see the patient with a speech pathologist, then come up with options. “This patient may do well with voice therapy alone,” he said.