Caution is also the preferred approach by Dr. Courey, who thinks that physicians too often diagnose vocal fold paresis based only on symptoms, even when the symptoms are nonspecific. This may cause the patient to give up on improving the way they use their voice through behavioral therapy, because the patients feel that they have a neurological problem rather than that they are just inefficient laryngeal users, he said. If they could learn to use their voices better, it would probably serve them better.
Explore This IssueApril 2009
Significance of What Is Seen: Whether to Treat
Whether to treat vocal fold paresis may be largely up to the patient, whereas how to treat may be linked more to the proclivities of the physician they see. For Dr. Merati, treatment is driven by the particular needs of the person experiencing the voice changes and is not always warranted.
But for those patients in whom even slight changes are problematic, treatment by injecting the vocal folds with a substance such as collagen offers an easy way to correct the condition.
For Dr. Merati, this ability to treat people in the office with simple injections, married to the recognition that even slight paresis can be a problem, has resulted in a lowered threshold for treating this condition.
People coming into the office complaining of vocal fatigue 10 years ago probably wouldn’t be getting treated for the same things they are getting treated for today, he said. The threshold for treatment has been lowered, and more people are being helped.
Dr. Sulica agreed that office-based injections are able to correct the vocal folds for paresis resulting in incomplete vocal fold closure, but emphasized that treatment is evolving. In some cases, like vocal fold paralysis, the paresis corrects itself over time, whereas in other cases, patients can compensate for the paresis with the remaining neuromotor function that is intact.
Favoring a more conservative approach, Dr. Courey emphasized the need to first help patients learn to function with limited vocal fold motion by teaching them to change the way they produce their voice to fit their laryngeal mechanism. He recommends surgery and injection to reposition the vocal fold only if this fails.
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