[The modern approach to the conservative treatment of the patients presenting with postoperative bilateral vocal fold palsy]. / Sovremennyi podkhod k konservativnomu lecheniiu bol'nykh s posleperatsionnym dvustoronnim narusheniem podvizhnosti golosovykh skladok.

The objective of the preset study was to further improve the diagnostics and treatment of unilateral palsies of the laryngeal recurrent nerves associated with transitory reflective spasm of the functionally competent vocal fold. The study included 49 patients (46 women and 3 men) at the age varying from 21 to 75 years presenting with unilateral palsies of the laryngeal recurrent nerves associated with transitory reflective spasm of the functionally competent vocal fold that developed after the surgical intervention on the thyroid gland. The electromyographic test for latent tetany was performed for diagnostics and objective evaluation of the results of the treatmen. In addition, the blood ionized calcium levels were measured and videolaryngostroboscopy was used. The treatment included respiratory gymnastics, reflexotherapy (novocaine blockade of the Zakhar'in - Head's zone for the larynx, auricolotherapy, and pharmacotherapy with the prescription of vitamin-calcium preparations, myorelaxants, sedatives, and phonopedia. A loud enough resounding voice was restored in all the 49 participants of the study with the normalization of respiration and the complete cessation (or reduction to a minimum) of the reflexive coughing spells and laryngeal reflex spasms. None of the patients required tracheotomy during the follow-up period.

In-Office Hyaluronate Injection Laryngoplasty as Palliative Treatment for Unilateral Vocal Fold Paralysis.

BACKGROUND: Voice and swallowing impairments can impact on both quality of life and survival. Unilateral vocal fold paralysis (UVFP) as a result of distant metastasis can cause breathy voice and aspiration. The purpose of this study is to develop and evaluate a less invasive and effective alternative therapy for UVFP. METHODS: This was a retrospective review of prospectively enrolled patients at a tertiary referral center in Taiwan. Among a cohort of 177 patients who received intracordal hyaluronate injections, 2 had UVFP from distant metastasis and met the inclusion criteria. Vocal cord motion was recorded by videostroboscopy, and the normalized glottal gap area was measured. Voice quality, defined by speech language pathologists, and swallowing status were compared, and immediate complications after the injection were investigated. RESULTS: Two patients with UVFP with M1 lesions (both lung) accepted the procedure. The glottal gap area was significantly improved 1 month after in-office hyaluronate injection. Voice quality and aspiration were also improved. No immediate complications were noted in either patient. CONCLUSIONS: In-office intracordal hyaluronate injection is a safe and effective treatment for UVFP, providing a palliative method to help maintain the patient's voice and quality of life.

Timing of nimodipine therapy for the treatment of vocal fold paralysis.

OBJECTIVES/HYPOTHESIS: To retrospectively determine optimal timing for initiation of nimodipine within a cohort of patients with acute vocal fold paralysis (VFP). STUDY DESIGN: Retrospective patient review. METHODS: Subjects were divided into three groups: initiation within 15 days postinjury (n = 19), between 15 and 30 days postinjury (n = 23), or greater than 30 days postinjury (n = 11). RESULTS: Fifty-one patients (53 paralyzed vocal folds [VFs]) met entrance criteria and were offered and started off-label nimodipine treatment. Thirty-six of 53 VFs recovered purposeful motion (67.9%). There was no significant difference in the rate of VF recovery among patients who began nimodipine within 15 days (68.4%), patients who started nimodipine between 15 and 30 days (73.9%) of nerve injury (P = .1405), and patients who initiated nimodipine after 30 days postinjury (54.5%). CONCLUSIONS: Nimodipine treatment for acute VFP yielded equal VF motion recovery rates regardless of when the medication was initiated. Time to recovery of motion was not different between groups studied.

Prospective investigation of nimodipine for acute vocal fold paralysis.

INTRODUCTION: Nimodipine has been shown to be beneficial for recovery from acute vocal fold paralysis (AVFP) in an animal model. METHODS: prospective, open-label trial of patients with AVFP was performed using nimodipine. Consecutive patients were evaluated and offered nimodipine therapy. RESULTS: Fifty-three patients were considered for treatment with nimodipine. Thirteen did not qualify for inclusion, 5 were lost to follow-up, and 7 had side effects requiring cessation of treatment. Thus 28 patients (30 paralyzed vocal folds) were analyzed. Eighteen of the paralyzed vocal folds experienced recovery of purposeful motion (60%). Historical controls and laryngeal electromyography meta-analysis suggest no more than a 20% recovery rate from AVFP. CONCLUSIONS: This open label study using nimodipine for treatment of AVFP demonstrates tripling of the recovery rate of vocal fold motion compared with historical controls. Further study in a randomized, controlled manner is warranted.

[Acupuncture in the combined treatment of patients with unilateral paralysis of the recurrent laryngeal nerve]. / Iglorefleksoterapiia v kompleksnom lechenii bol'nykh s odnostoronnim paralichom vozvratnogo gortannogo nerva.

Fourteen patients with unilateral paralysis of the recurrent laryngeal nerve underwent a combined therapy which included acupuncture, phonopedics, respiratory muscle gymnastics, prozerin administration by means of sinusoidal modulated currents, and intramuscular injection of B1 and B6 vitamins. Before and after treatment the vocal function was assessed using indirect laryngoscopy, laryngostroboscopy, larynx tomography and thermography, larynx endophotography, voice tape recording, and maximum phonation time measurement. The combined treatment yielded good results in all patients in terms of the recovery of their vocal function. In 11 patients the recovery was reached within 2-3 weeks and in 3 remaining patients within 2-3 months. It is maintained that the recovery was expedited due to the beneficial effect of acupuncture and phonopedics.

Experience with vocal cord injection.

For 14 years investigators accredited by the FDA have been injecting a Teflon - glycerin mixture into lateral-lying, paralyzed vocal cords. This paper represents a summary of the work of this author, including successes, failures, and complications; it is the largest reported series, plus that of accredited investigators. The method described is exceptionally useful; it has restored voices, laughter, the ability to strain, and has prevented aspiration. A new surgical technique involving the injection of sterile glycerin into comparable vocal cords in acute new situation is also described. This is done by direct or indirect laryngoscopy, and has been used to eliminate some tracheotomy surgery by virtue of the immediately improved cough effectiveness.