Iatrogenic vocal fold paralysis can result from stretching, compression or complete transection of recurrent laryngeal or vagus nerves. These injuries are a significant source of concern for patients and clinicians alike. The question is how long should we wait for the nerve to recover before concluding that the deficit is permanent? This paper seeks to provide clarification to that question. In doing so, it can help us plan the timing of permanent interventions such as framework surgery. They identified 293 cases of iatrogenic vocal fold paralysis presenting to one institution over a 10-year period. The majority had surgery in the neck (hemi‐ or complete thyroidectomy, parathyroidectomy, neck dissection) with others having had surgery at the skull base, carotid endarterectomy or thoracic surgery. Patients with vocal fold paralysis after intubation were also included. A total of 114 patients were suitable for further analysis. Of these patients, 102 (89.5%) recovered function. Of those recovering, 63 had been treated temporarily with vocal cord injections. Of the 12 (10.5%) patients who did not recover, three had been treated with injection augmentation. The longer the paralysis persisted, the less likely it was to eventually recover. Of those presenting one month post-surgery, 81% would go on to recover, whereas at 11 months, less than 35% of patients presenting with unresolved issues eventually recovered. Mean time to recovery was 181.8 ± 109.3 days. When the clinician is sure the nerve has not been transected but the vocal fold is immobile, there can be a nervous wait for function to return. This paper helps to clarify just how long that wait can be.

Time course of recovery of idiopathic vocal fold paralysis.
Husain S, Sadoughi B, Mor N, et al.
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Sarj Vasani

Royal Brisbane Hospital, Brisbane Australia.

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