Unilateral Vocal Fold Paralysis

Abstract

Voice samples of 16 adult patients with vocal fold paralysis and 6 normal adults were recorded and evaluated by 27 listeners (9 speech-language pathologists, 9 otolaryngologists, and 9 lay listeners). The listeners rated the voices of the speakers on a 10-point scale on six vocal parameters (pitch, loudness, hoarseness, vocal roughness, breathiness, and overall quality). The 16 patients represented three different treatment approaches (teflon injection, 4; voice therapy, 6; and muscle-nerve reinnervation surgery, 6). Voice therapy and muscle nerve reinnervation surgery were both rated more successful than teflon injection in terms of improvement from pretreatment to posttreatment voices for all six vocal parameters. Normal speakers’ voices were rated higher than the voices of any treatment group. Speech-language pathologists were more reliable listeners than the other two listener groups. A case is made for using a period of trial voice therapy while waiting for possible spontaneous nerve healing in unilateral vocal fold paralysis patients who do not have aspiration problems and who have a competent cough. The majority of patients studied presented with unilateral recurrent laryngeal nerve paralysis, and none recovered vocal fold function during the course of the study.