Patients with voice problems caused by a paralyzed vocal fold now have more options when considering surgery to restore their voices. Results of a multi-center clinical trial published in the Oct. 2011 issue of the journal Laryngoscope offer people with vocal fold paralysis new information about a surgical procedure called laryngeal reinnervation, which essentially re-wires the voice box with a new nerve supply.
University of Utah faculty members Marshall E. Smith, M.D., professor of otolaryngology, and his colleague Nelson Roy, Ph.D., associate professor of speech and language pathology, participated in this multi-center study spearheaded by researchers in St. Louis and involving a total of nine universities. Eight vocal cord paralysis patients from Utah were enrolled in this randomized trial comparing improvement in voice function following two different surgical treatments -- medialization and reinnervation.
鈥淰oice problems caused by vocal fold paralysis are a very common problem that every ear-nose-throat specialist is familiar with,鈥 said Smith. 鈥淭his new research comparing medialization and reinnervation approaches to vocal fold paralysis is extremely important in the field of voice since there are so few prospective randomized trials in our specialty.鈥
In unilateral, or one-sided, vocal fold paralysis, the vocal folds fail to meet in the middle when they close, resulting in a weak, breathy voice. Medialization surgery for vocal fold paralysis involves placing an implant through a surgically-created window in the larynx, or voice box. This implant pushes the paralyzed vocal fold toward the midline, helping the vocal folds to meet when they close. Reinnervation surgery, on the other hand, involves borrowing a nerve from a nearby muscle in the neck and reconnecting it to the paralyzed vocal fold, providing a new nerve supply.
The two surgical procedures were compared by looking at the voice function of patients up to one year following surgery. While both procedures were effective in improving voice, the researchers found that among study participants under the age of 52, the reinnervation procedure produced better voice function, based on ratings provided by both the patients themselves and blinded listeners. Older patients seemed to have slightly better results with the medialization procedure.
鈥淚t may be that younger patients have better results with the reinnervation procedure because they have a greater potential to heal and regenerate nerves than older patients,鈥 suggested Smith. 鈥淚n our previous research, Dr. Roy and I reported excellent results with reinnervation in adolescent and young adult patients with vocal fold paralysis.鈥
Medialization is currently the favored and most common surgical intervention for unilateral vocal fold paralysis because improvement in voice begins soon after the procedure. Despite previous reports showing the effectiveness of reinnervation, this alternative has not gained widespread acceptance, in part because voice improvements might be delayed while the new nerve connections heal.
鈥淎lthough there is a three- to five-month delay in voice improvement, this study indicates that the clinical benefits of reinnervation may be worth the wait, especially for younger patients,鈥 concluded Smith. 鈥淗opefully, based on these results, voice care specialists around the country will give the reinnervation option much more consideration than they previously have.鈥
Smith and Roy are both researchers at the University of Utah Voice Disorders Center, one of the first multidisciplinary clinics specializing in voice in the U.S., and a national leader in voice care and voice research for over 20 years.