Vocal Cord Paralysis After Tracheostomy: Treatment Options

Suspected tracheostomy leading to nerve damage resulting in vocal cord paralysis?

Hello Doctor, last March I was sent to the emergency room due to a car accident and required an emergency tracheostomy.
Two days later, the physician decided to reposition the tracheostomy because the initial placement was deemed suboptimal.
This may have caused nerve damage, resulting in unilateral vocal cord paralysis and some fibrosis.
Although I underwent vocal cord injection with hyaluronic acid in April this year, my voice remains hoarse and unsatisfactory.
Are there any other reinforcement options available?
Regarding thyroid cartilage augmentation, will there be a sensation of a foreign body or discomfort postoperatively? I found information online about nerve reconstruction; how effective is this for improving vocal cord paralysis? I noticed that not many hospitals seem to perform nerve reconstruction.
Should I consult an otolaryngologist or a neurosurgeon for this? Or do you have any other recommendations? Thank you for your response, Doctor.

Xiao Ji, 30~39 year old female. Ask Date: 2024/05/07

Dr. Ji Zhaoyun reply Otolaryngology

Here are some suggestions and information regarding your unilateral vocal cord impairment issue:
1.
Alternative Reinforcement Methods: - Vocal cord injection with hyaluronic acid is a treatment option for vocal cord paralysis, but its effectiveness varies from person to person.
In addition to hyaluronic acid injections, there are other treatment options available, such as vocal cord surgical repair or the use of other injectable substances.
It is recommended that you discuss with an otolaryngologist to explore other suitable treatment options for your condition.
2.
Thyroplasty: - Thyroplasty is a surgical method used to restore vocal cord function.
After the surgery, you may experience temporary sensations of foreign body presence or discomfort, but these feelings typically diminish as recovery progresses.
It is important to consult with the surgeon in detail before the procedure to understand the surgical process, risks, and recovery expectations.
3.
Nerve Reconstruction: - Currently, in Taiwan, the primary treatments for unilateral vocal cord paralysis include the aforementioned two treatments along with speech therapy.
Therefore, it is advisable to seek opinions from specialists in otolaryngology or neurology.
When choosing a hospital and physician, you may inquire about their relevant experience and expertise.
4.
Additional Recommendations: - Besides medical treatment, the rehabilitation of vocal cord function also requires guidance and training from a speech therapist.
Speech therapy can help you maximize vocal cord function and improve your speech expression abilities.
Finally, it is recommended that you seek advice from a professional otolaryngologist or neurologist to further assess your condition and develop a suitable treatment plan.
Wishing you a speedy recovery and the restoration of your ideal voice condition.

Reply Date: 2024/05/07

More Info

Vocal cord paralysis can be a challenging condition, especially following a tracheostomy, as you've experienced. The paralysis can lead to significant voice changes, including hoarseness and difficulty speaking, which can be frustrating and impact your quality of life. Let's explore the treatment options available for vocal cord paralysis and address your specific concerns.

Treatment Options for Vocal Cord Paralysis
1. Voice Therapy: Since you have already undergone voice therapy with some improvement, it’s worth noting that ongoing voice therapy can still be beneficial. A speech-language pathologist specializing in voice disorders can help you develop techniques to optimize your voice production and manage the hoarseness. While it may not restore full function, it can improve voice quality and reduce strain.

2. Vocal Cord Injection: You mentioned that you had a hyaluronic acid injection, which is a common procedure to bulk up the paralyzed vocal cord and improve voice quality. If the results were not satisfactory, you might consider repeating the injection or trying different materials, such as collagen or fat grafting, which can also be used to augment the vocal cord.

3. Surgical Options:
- Thyroplasty: This procedure involves placing an implant in the thyroid cartilage to reposition the paralyzed vocal cord closer to the midline, allowing better closure during phonation. Patients often report a sensation of fullness or pressure in the throat postoperatively, but this typically resolves over time.

- Arytenoid Adduction: This surgery repositions the arytenoid cartilage to improve vocal cord closure. It can be performed in conjunction with thyroplasty for better outcomes.

- Nerve Reinnervation: This is a more complex procedure where a functioning nerve is connected to the paralyzed vocal cord. While it has shown promise in some cases, the availability of this procedure can be limited, and it requires a specialized surgical team.

4. Nerve Reconstruction: As you mentioned, nerve reconstruction is an option that may help restore function to the vocal cords. This procedure is typically performed by a neurosurgeon or an otolaryngologist with expertise in nerve repair. The success of this procedure can vary based on the extent of the nerve damage and the time elapsed since the injury.

Choosing the Right Specialist
Given the complexity of your condition, it is advisable to consult with both an otolaryngologist (ENT) and a neurosurgeon. The ENT can evaluate your vocal cord function and discuss surgical options like thyroplasty or arytenoid adduction. If nerve reconstruction is a consideration, the neurosurgeon can assess the feasibility and potential outcomes of such a procedure.

Additional Considerations
- Postoperative Care: After any surgical intervention, it’s crucial to follow up with your healthcare provider to monitor your recovery and voice function. Voice rest and rehabilitation are often recommended post-surgery to allow for optimal healing.

- Patient Support: Joining a support group for individuals with voice disorders can provide emotional support and practical advice from others who have faced similar challenges.

Conclusion
In summary, while vocal cord paralysis can be a persistent issue following a tracheostomy, there are several treatment options available, ranging from voice therapy to surgical interventions. Each option has its benefits and potential drawbacks, so it’s essential to have a thorough discussion with your healthcare providers to determine the best course of action tailored to your specific situation. Your proactive approach in seeking further treatment is commendable, and I encourage you to continue exploring these options to improve your voice quality and overall well-being.

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If possible, please discuss more with your attending physician.