Should Injection Laryngoplasty Be Performed for Acute Unilateral Vocal Fold Paralysis to Improve Swallowing Safety?

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BACKGROUND

Otolaryngology services are commonly consulted to evaluate inpatients for voice and swallowing dysfunction from acute unilateral vocal fold paralysis (UVFP) caused by iatrogenic or neurogenic injury to the vagus or recurrent laryngeal nerve. Among the morbid complications of UVFP is aspiration pneumonia, which has been associated with extended length of stay and increased mortality risk. Therefore, consulting teams often ask otolaryngologists to consider performing injection laryngoplasty (IL) to decrease the risk of aspiration.

Although outpatients with voice and swallowing complaints are often referred to otolaryngologists who diagnose UVFP and may perform IL under local anesthesia in the office setting, availability of early IL for inpatients is more limited. Many hospitals do not have otolaryngologists who are trained in performing awake IL or have access to the equipment needed for bedside procedures, and intervention may require a general anesthetic for patients who may be in critical condition.

Our objective here is to succinctly summarize recent literature findings to guide practicing otolaryngologists in the evaluation of inpatients with acute UVFP and identification of appropriate candidates for early IL.

BEST PRACTICE

For inpatients with acute UVFP for which IL can be performed safely and proficiently, its proven benefits for voice, cough effectiveness, and potential improvements in swallowing safety with protection from aspiration pneumonia make it worth pursuing. Patients with severe swallowing dysfunction from acute high vagal injury may not improve significantly after IL. Prospective controlled trials are needed to further establish and understand the protective benefits with respect to aspiration pneumonia prevention of early inpatient IL compared to delayed outpatient IL and to no procedural intervention in acute UVFP.