Surgical management of vocal cord paralysis: The need for careful patient selection

Abstract

Background: Vocal cord paralysis is one of the challenging laryngeal clinical entities confronting the Laryngologist and indeed, the Phono-surgeon. The ability to maintain an effective balance between voice and airway function to ensure good quality of life, which is the overall surgical management strategy, requires expertise. Method: Clinical notes of all patients that met the inclusion criteria for this study on vocal cord paralysis over a ten-year period were analyzed. Data was generated from patients' case files retrieved using standard codes according to the International Classification of Diseases(lCD-10). Results: From the 7,941 new ENT cases seen,26 patients had vocal cord paralysis (VCP) which translates to a prevalence of 0.3%. The male to female ratio was 1: 4.2 with a mean age of 45.7years ± 6.3. Their ages ranged from 21-80 years. Thyroidectomy was the main causal factor in 46.2% while idiopathic causes were documented in23.1 %. Twenty-three patients (88.5%) had unilateral VCP from which 21(91.3%) were abductor paralysis. The ratio of Left: Right VCP was 3:1. All the 3(11.5%) bilateral cases were abductor paralysis. Neurotropic agents only, were effective in cases of unilateral VCP. However, in those with bilateral paralysis, two had tracheostomy only, while the third had alaryngo-fissure, arytcnoidoplasty and endo-laryngeal stenting in addition. All were successfully decannulated with good voice quality. With these observations, we suggest the choice of appropriate surgical technique, timing and careful patient selection in order to preserve voice, curtail operative sequelae and achieve good health related quality of life (HRQoL) which is the overall management strategy, be borne in mind in the surgical management of vocal cord paralysis.