Post-Surgery Vocal Cord Paralysis: Treatment Options and Insights

Treatment options for vocal cord paralysis after surgery?

Hello, Doctor: I underwent a thoracic aortic aneurysm resection and artificial graft repair in 2004.
After the surgery, my left vocal cord became immobile, resulting in hoarseness and vocal fatigue.
I participated in voice rehabilitation for about a year, which led to some improvement (although I did not fully commit to the rehabilitation), but my voice remains unstable and I still experience hoarseness and loss of voice easily.
Additionally, my left vocal cord remains immobile, while my right vocal cord has shifted slightly towards the midline.

I have received rehabilitation at two different hospitals; Hospital A stated that rehabilitation could restore my voice to 80-90%, while Hospital B mentioned that the vocal cord issue is unlikely to improve significantly, although my voice might get somewhat better.
They recommended surgery to address my hoarseness.
Given that I have been experiencing hoarseness for a long time, I am considering surgery for improvement, but I have limited information regarding voice-related issues.
Therefore, I would like to ask you a few questions:
1.
Can ongoing rehabilitation improve the immobility of the vocal cord caused by surgery?
2.
Regarding vocal cord repair surgery, which surgical methods are more suitable for me, such as silicone implantation, laryngeal framework surgery, or the midline approach? What are the potential complications associated with each method?
3.
Could you recommend any hospitals or doctors that specialize in voice clinics or surgeries?

Grace, 20~29 year old female. Ask Date: 2006/12/27

Dr. Ye Dawei reply Otolaryngology

Hello.
1.
In the case of complete paralysis, theoretically, there should be no improvement; however, the other side may compensate.
2.
This is a procedure that requires a medical center-level facility, which our hospital is unable to perform.
3.
Dr.
Hsiao Tzu-Yu from National Taiwan University and Dr.
Su Chih-Ying from Kaohsiung Chang Gung Memorial Hospital.

Reply Date: 2006/12/27

More Info

Post-surgery vocal cord paralysis can be a challenging condition to manage, especially after significant surgeries like a thoracic aortic aneurysm repair. Your experience of left vocal cord immobility and persistent hoarseness is not uncommon in such cases, and it’s understandable that you are seeking further treatment options to improve your voice quality and overall communication ability.

1. Rehabilitation and Recovery: After surgery, vocal cord paralysis can sometimes improve with continued speech therapy and vocal rehabilitation. While some patients may experience spontaneous recovery, others may not see significant changes in vocal cord movement. Engaging in consistent voice therapy can help optimize the function of the remaining healthy vocal cord and improve voice quality. However, if the left vocal cord remains immobile, the focus will likely be on maximizing the function of the right vocal cord and learning techniques to compensate for the lack of movement on the left side.

2. Surgical Options: There are several surgical interventions available for vocal cord paralysis, each with its own indications, benefits, and potential complications.
- Medialization Laryngoplasty: This procedure involves placing a material (such as silicone) to push the paralyzed vocal cord closer to the midline, allowing for better closure during phonation. This is often the first-line surgical option for improving voice quality in cases of unilateral vocal cord paralysis.

- Laryngeal Framework Surgery: This includes procedures like the thyroplasty, which can also help in repositioning the vocal cords. The choice between silicone implants or other materials depends on the surgeon's preference and the specific anatomy of your larynx.

- Reinnervation Procedures: These are more complex surgeries that attempt to restore nerve function to the vocal cords. They may be considered if there is a chance of nerve recovery or if the paralysis is recent.

- Risks and Complications: Each surgical option carries risks, including infection, bleeding, and potential changes in voice quality. There is also a risk of over-correction or under-correction, which may necessitate further procedures. It’s crucial to discuss these risks with your surgeon to understand what to expect.

3. Finding Specialists: It’s essential to consult with an otolaryngologist (ENT specialist) who has experience in voice disorders and surgical interventions for vocal cord paralysis. Many academic medical centers have specialized voice clinics or laryngology departments. You might want to look for institutions that offer multidisciplinary care, including speech-language pathologists who specialize in voice therapy. They can provide a comprehensive approach to your condition, combining surgical and non-surgical treatments.

In summary, while surgical options may provide a pathway to improve your voice quality, the decision should be made in collaboration with a specialist who can assess your specific situation and recommend the best course of action. Continuing with voice therapy is also essential, as it can help you adapt and potentially improve your vocal function over time. Don’t hesitate to seek a second opinion if you feel uncertain about the recommendations you’ve received. Your voice is an important aspect of communication, and it’s worth exploring all available options to enhance your quality of life.

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