Vocal Fold Paralysis Recovery Time Linked to Nerve Injury Site

By Reuters Staff

December 06, 2019

NEW YORK (Reuters Health) - Level of injury in patients with unilateral vocal fold paralysis (UVFP) is associated with maximum time to recovery, according to new case series.

The greater the distance from vocal fold to nerve injury site, the longer the maximum recovery time, Dr. Dong-Han Lee of Seoul National University College of Medicine in South Korea and colleagues found.

"These findings suggest that injury-based counseling is warranted for optimal timing of permanent treatment for patients with unilateral vocal fold paralysis," the authors write in JAMA Otolaryngology-Head and Neck Surgery, online November 21.

Permanent surgical treatment for UVFP is recommended when patients are unlikely to show continued recovery of neural function, the authors note. "However, there is little information about the difference in recovery pattern according to different causes of paralysis in the literature."

The researchers looked at 1,264 patients with UVFP treated at their voice clinic in 2005-2016, 208 of whom showed signs of recovery during follow-up, which lasted a median 385 days.

Among these 208 patients, 7.7% had injury distal to the thyroid, 10.1% at thyroid level, 20.2% at the esophagus and mediastinum, 20.7% at the heart and lung level, and 41.3% proximal to the thorax.

Maximum time to recovery was 120 days in patients with distal-to-thyroid injury, 157 days for thyroid-level injury, 244 days for esophagus-and-mediastinum-level injury, 328 days for heart-and-lung level injury, and 333 days for injury proximal to the thorax. Median recovery times were 49.5 days, 70.0 days, 113.5 days, 61.0 days and 75.5 days, respectively.

"This finding suggests that if UVFP has not begun to recover within 6 months after a thyroid surgical procedure, permanent surgical intervention may be considered because recovery is otherwise unlikely," Dr. Lee and colleagues write. "For patients with UVFP secondary to esophageal and mediastinal surgery, heart and lung surgery, vagus nerve injury, brain surgery, or idiopathic cause, the findings suggest that permanent surgical intervention may be considered 1 year after the initial onset."

Age, sex and paralytic side were not associated with recovery time.

The researchers conclude, "A treatment policy for the optimal timing of permanent intervention may be associated with reduced unnecessary deterioration of quality of life among patients with UVFP."

SOURCE: https://bit.ly/2qJ3nmB

JAMA Otolaryngol Head Neck Surg 2019