Laryngeal Reinnervation for Unilateral Vocal Fold Paralysis: Are We Ready

Further, there is the fact that outcomes from laryngeal reinnervation have not been prospectively compared with other medialization procedures. One multicenter trial, sponsored by the NIH and initiated in 2003 with Randal Paniello, MD, of the University of Washington in St. Louis as lead investigator, has now been discontinued. Dr. Merati bemoaned the lack of prospective, randomized data. One of the things that makes it hard to promote reinnervation is that the success of implants is pretty good, he said. So, without a randomized trial, it’s hard to show that reinnervation is better.

The Real Barrier

Still, Dr. Crumley asserted, Reinnervation is a proven procedure. He pointed to large series reported throughout the United States, Europe, and Asia. And Dr. Blumin believes that reinnervation is an option that really fits with some patients. Most of those interviewed here believe that reinnervation has the potential for growth. Dr. Crumley is planning to bring some worldwide experts in reinnervation to the ALA’s May 2009 meeting in Phoenix.

Dr. Merati believes there is an even bigger problem impeding the increased use of reinnervation: the reservoir of patients with vocal cord problems who are not referred to otolaryngologists. There are thousands of patients every year whose physicians tell them that there is nothing that can be done for their hoarseness, and patients sit there, humbly, waiting for their voices to come back. I can’t tell you how many times a week I see patients who say, ‘Wow, I was told there was nothing I could do, or that I had to wait for a year.’

In that sense, he said, trying to decide which treatment for paralysis is the best is a wonderful question to have!

References

1. Blumin JH, Merati AL. Laryngeal reinnervation with nerve-nerve anastomosis versus laryngeal framework surgery alone: a comparison of safety.
2. Otolaryngol Head Neck Surg 2008;138(2):217-20. 2. Crumley RL, Izdebski K, McMicken B. Nerve transfer versus Teflon injection for vocal cord paralysis: a comparison. Laryngoscope 1988;98:1200-4. 3.
3. Chhetri DK, Gerratt BR, Kreiman J, Berke GS. Combined arytenoid adduction and laryngeal reinnervation in the treatment of vocal fold paralysis. Laryngoscope 1999;109(12):1928-36.

©2009 The Triological Society