Unilateral vocal cord paralysis which is not due to irreversible causes such as malignancy, systemic disease or trauma varies considerably in terms of full recovery and restoration of voice. Usually electromyography is used to make possible predictions, but this facility is not universally available nor is the prognosis easy to determine. In this elaborate, well illustrated study, the authors have elicited details of vocal fold and arytenoid positions and vertical levels of affected fold in patients of unilateral vocal cord paralysis through repeated six week endoscopic observations for six months following detection of vocal fold paralysis. Individual muscle movements in the anterior and posterior parts of the vocal folds were assessed for adduction and abduction. Exact position of the vocal fold from median to lateral was noted, as was that of arytenoids – posteromedial, posterolateral and lateral. Compensatory movement of the normal cord was observed in the recovery phase. An interesting finding was that posterolateral tilt of the paralysed arytenoid had least or no chance of recovery. With these findings, it was also possible to predict the need for intervention, such as in cases where there is a lack of compensatory movement of the unaffected cord or vertical level incompatibility. Based on this study, supported by statistics, a useful algorithm has been presented demonstrating types of thyroplasty required in specific situations, or whether observation and voice therapy alone would do. This should provoke some interesting feedback. 

Unilateral vocal fold paralysis: can laryngoscopy predict recovery? A prospective study.
Menon JKR, Nair RM, Priyanka S.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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