ENTtoday
  • Home
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Treating Vocal Fold Paralysis with Medialization

by Thomas R. Collins • November 16, 2016

  • Tweet
  • Email
Print-Friendly Version
© Bartleby.com: Gray’s Anatomy, Plate 1204

Larynx.
© Bartleby.com: Gray’s Anatomy, Plate 1204

Treating vocal fold paralysis with medialization involves a series of decisions that can sometimes be difficult to make. A panel of experts assembled at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting to give tips to session attendees on the best approaches to surgical timing and technique, and to explain how to determine whether medialization is needed at all.

You Might Also Like

No related posts.

Explore This Issue
November 2016

Pre-Procedure Decisions

David Francis, MD, MS, assistant professor of otolaryngology at the Vanderbilt Voice Center in Nashville, said there is often a several-month delay before someone with unilateral vocal fold paralysis actually sees a voice specialist. If a patient sees a general otolaryngologist before seeing the voice physician, it takes a median of nine months to be seen by the voice specialist. “This has significant implications for treatment planning,” he said.

The decision of whether and when to perform an injection augmentation or type I laryngoplasty requires an understanding of the physiology, along with audio-perceptual, visual-perceptual and, importantly, patient-reported factors.

When a patient comes in with vocal fold paralysis, physicians should immediately start thinking about the long-term approach. “We should be thinking about how we’re going to work up these patients and how to manage and measure outcomes systematically,” Dr. Francis said.

The question of whether imaging is needed is a matter of some controversy, he added, although there’s been a “long history” of obtaining a computerized tomography (CT) scan to assess the recurrent laryngeal nerve. “A consensus still exists that some imaging should be done to rule out mass lesions along the recurrent laryngeal nerve in most cases,” he said.

Timing from symptom onset to presentation is a key consideration when determining management. Dr. Francis said that it can take six to 12 months for the nerve to regenerate back to the laryngeal muscles it innervates after denervation injury. Determining whether and when recovery will occur is complicated; often, it is not known where the nerve is injured, how severely it is injured, and what the odds of recovery are.

He also noted that “recovery” doesn’t necessarily mean a return to normal vocal fold mobility; it is more important that symptoms improve significantly enough that a patient no longer feels that the surgery is necessary. Some patients do not experience a voice change that is severe or important enough for them to want surgery. “Even when surgeons may perceive the voice as being disordered, we must be careful not to project our biases and conceptions on these patients,” he said. Decisions about management of this condition should be patient centered and not physician centered.

Injection Laryngoplasty

Andrew McWhorter, MD, director of the Louisiana State University Voice Center in Baton Rouge, said that there is a general belief that the earlier an injection augmentation is done, the better the result. But, he said, this may not be true. Published data suggest that injection diminishes the percentage of patients eventually needing framework surgery, but it is debatable whether the timing factors into this outcome.

Pages: 1 2 3 4 | Single Page

Filed Under: Features Tagged With: AAO-HNS Meeting, American Academy of Otolaryngology- Head and Neck Surgery Annual Meeting, medialization, treatment, vocal fold paralysisIssue: November 2016

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Keeping Watch for Skin Cancers on the Head and Neck
    • Vertigo in the Elderly: What Does It Mean?
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • What Happens to Medical Students Who Don’t Match?
    • Complications for When Physicians Change a Maiden Name
    • Resident Unions Are Growing in Popularity in Otolaryngology
    • Is Caring for the Homeless and Uninsured Really Someone Else’s Problem?
    • Otolaryngology Practices Use Digital Tools to Pre-authorize—With Mixed Results
    • A Look at the Past, Present, and Future of DEI Medical Education Initiatives
    • Barbie, Bullying, and Bravery: Ending Workplace Bullying Requires Strong Leadership

Polls

Do you think resident unions are a positive development for otolaryngology?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2023 The Triological Society. All Rights Reserved.
ISSN 1559-4939