Tailored Treatments: The right approach to vocal fold paralysis depends on the patient, panelists say

A major disadvantage of reinnervation is that it can take four to eight months to see results, which might make it a bad option for patients who need their voices back immediately for work or other reasons, he said.

Arytenoid Adduction

Gayle Woodson, MD, chair of otolaryngology at Southern Illinois University in Springfield, said arytenoid adduction, in which the arytenoid cartilage is rotated to medialize the vocal process, can be useful in patients with posterior glottic incompetence. It can be combined with a Type 1 thyroplasty for better results.

The reverse of this procedure, arytenoid abduction, is a “promising” treatment for bilateral laryngeal paralysis, she said.

Arytenoid adduction is frequently performed when there is an urgent need on the part of the patient, she said.

“There’s only a certain group of patients that it’s indicated in,” she said. “The patients that I’ve run into that need it the most are the ones that have a really incompetent larynx because their vocal fold is very lateral. A lot of times they have difficulty swallowing and really the need to get them swallowing is the urgent indication.”

Even if the need is less urgent, the procedure might be a good option. Certain patients might be able to get the best voice by getting the arytenoid position “right where you want it,” Dr. Woodson said.