Evaluation and Management of Unilateral Vocal Fold Paralysis

Unilateral vocal fold paralysis (UVFP) occurs due to neurologic dysfunction that arises anywhere along the course of the vagus or recurrent laryngeal nerve (RLN). Patients most commonly experience dysphonia and varying degrees of dysphagia and dyspnea. The most common causes of UVFP include iatrogenic (i.e. thyroid, cardiac, or esophageal surgery), tumors/masses along the course of the vagus or RLN, and idiopathic. Initial evaluation includes a careful history, voice assessment, and laryngeal examination. Adjunctive tests can include computed tomography scans of the neck/chest and laryngeal electromyography. Depending on the severity of the patient’s symptoms and goals for rehabilitation, treatment options encompass observation, speech therapy, injection augmentation, and surgery. This review will provide valuable insight for both junior and senior Otolaryngology residents as they learn to manage these patients during residency and beyond. Keywords: Unilateral vocal fold paralysis, general laryngeal anatomy, injection augmentation, type I thyroplasty, arytenoid adduction, laryngeal reinnervation