Abstract
Purpose of Review
Dysphagia secondary to unilateral vocal fold paralysis (UVFP) is the result of glottic incompetence, reduced supraglottic sensation, and impaired function of the upper esophageal sphincter (UES). UVFP resultant dysphagia is of the utmost importance for those patients who have undergone thoracic and mediastinal surgeries. Management options for UVFP associated dysphagia are aimed at improving glottic closure including injection laryngoplasty and type I thyroplasty. This article presents a state-of-the-art overview of pathophysiology, presentation, and treatment of dysphagia in vocal fold paralysis.
Recent Findings
Patients with UVFP report significantly increased dysphagia symptom scores and demonstrate pharyngeal muscle weakness. The risk of dysphagia in UVFP is increased by the inability of the bolus to develop adequate speed or consistency and compromised UES opening. Injection laryngoplasty within 4.5 days of onset of UVFP is associated with decreased incidence of aspiration pneumonia and shortened length of stay. Cough strength increases after injection laryngoplasty in those patients with UVFP.
Summary
Patients with UVFP are more likely to develop aspiration pneumonia. Patient outcomes are best with early intervention restoring glottic competence.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
• Miles A, McLellan N, Machan R, et al. Dysphagia and laryngeal pathology in post-surgical cardiothoracic patients. J Crit Care. 2018;45:121–7 Aspiration pneumonia is particularly perilous for patients who have recently undergone cardiothoracic surgery.
•• Zuniga S, Ebersole B, Jamal N. Inpatient injection laryngoplasty for vocal fold immobility: when is it really necessary? Am J Otolaryngol. 2017;38(2):222–5 Salient paper proving the benefit of early injection laryngoplasty after onset of vocal fold paralysis.
•• Francis DO, Sherman AE, Hovis KL, et al. Life experience of patients with unilateral vocal fold paralysis. JAMA Otolaryngol Head Neck Surg. 2018;144(5):433–9 The only published work discussing vocal fold paralysis from the patient perspective.
Leder SB, Ross DA. Incidence of vocal fold immobility in patients with dysphagia. Dysphagia. 2005;20(2):163–7 discussion 168-169.
Chhetri DK, Dewan K. Dysphagia evaluation and management in otolaryngology. St. Louis, Missouri: Elsevier; 2019.
Francis DO, McKiever ME, Garrett CG, Jacobson B, Penson DF. Assessment of patient experience with unilateral vocal fold immobility: a preliminary study. J Voice. 2014;28(5):636–43.
Heitmiller RF, Tseng E, Jones B. Prevalence of aspiration and laryngeal penetration in patients with unilateral vocal fold motion impairment. Dysphagia. 2000;15(4):184–7.
•• Erdur O, Gul O, Ozturk K. Evaluation of upper oesophageal sphincter in unilateral vocal fold paralysis. J Laryngol Otol. 2019;133(2):149–54 The only report of the impact of unilateral vocal fold paralysis on function of the upper esophageal sphincter.
• Crowson MG, Tong BC, Lee HJ, et al. Vocal fold paralysis/paresis as a marker for poor swallowing outcomes after thoracic surgery procedures. Dysphagia. 2019;34(6):904–15 Salient article regarding the impact of vocal fold paralysis on swallowing outcomes in patients who have undergone thoracic surgery.
•• Tsai MS, Yang YH, Liu CY, et al. Unilateral vocal fold paralysis and risk of pneumonia: a nationwide population-based cohort study. Otolaryngol Head Neck Surg. 2018;158(5):896–903 Unique paper as it is the only large cohort study of the impact of unilateral vocal fold paralysis.
•• Dion GR, Achlatis E, Teng S, et al. Changes in peak airflow measurement during maximal cough after vocal fold augmentation in patients with glottic insufficiency. JAMA Otolaryngol Head Neck Surg. 2017;143(11):1141–5 This only study on cough strength in relation to vocal fold paralysis.
Giraldez-Rodriguez LA, Johns M 3rd. Glottal insufficiency with aspiration risk in dysphagia. Otolaryngol Clin N Am. 2013;46(6):1113–21.
Domer AS, Leonard R, Belafsky PC. Pharyngeal weakness and upper esophageal sphincter opening in patients with unilateral vocal fold immobility. Laryngoscope. 2014;124(10):2371–4.
•• Zuniga S, Ebersole B, Jamal N. Improved swallow outcomes after injection laryngoplasty in unilateral vocal fold immobility. Ear Nose Throat J. 2018;97(8):250–6 This study proves the efficacy of injection laryngoplasty in decreasing the risk of aspiration in unilateral vocal fold paralysis.
• Fourdrain A, De Dominicis F, Iquille J, et al. Usefulness of a routine endoscopic assessment of laryngeal lesions after lung cancer surgery. Respirology. 2018;23(1):107–10 Salient paper on the diagnosis of unilateral vocal fold paralysis after lung cancer surgery.
•• Kumai Y, Miyamoto T, Matsubara K, et al. Determining the efficacy of the chin-down maneuver following esophagectomy with fiberoptic endoscopic evaluation of swallowing. Arch Phys Med Rehabil. 2019;100(6):1076–84 Discussion regarding the management of aspriation in unilateral vocal fold paralysis.
Matsubara K, Kumai Y, Miyamoto T, et al. The effect of a chin-down maneuver after esophagectomy on oropharyngeal swallowing pressure measured using high-resolution manometry. Auris Nasus Larynx. 2020;47(1):141–7.
Crawley BK, Sulica L. Vocal fold paralysis as a delayed consequence of neck and chest radiotherapy. Otolaryngol Head Neck Surg. 2015;153(2):239–43.
• Dewan K. Chemotherapy and dysphagia: the good, the bad, the ugly. Curr Opin Otolaryngol Head Neck Surg. 2020;28(6):385–91 Explaination of the pathophysiology of radiation induced vocal fold paralysis and its impact on swallow function.
Best SR, Ahn J, Langmead S, et al. Voice and swallowing dysfunction in neurofibromatosis 2. Otolaryngol Head Neck Surg. 2018;158(3):505–10.
Daniero JJ, Garrett CG, Francis DO. Framework surgery for treatment of unilateral vocal fold paralysis. Curr Otorhinolaryngol Rep. 2014;2(2):119–30.
Cates DJ, Venkatesan NN, Strong B, Kuhn MA, Belafsky PC. Effect of vocal fold medialization on dysphagia in patients with unilateral vocal fold immobility. Otolaryngol Head Neck Surg. 2016;155(3):454–7.
Ollivere B, Duce K, Rowlands G, Harrison P, O'Reilly BJ. Swallowing dysfunction in patients with unilateral vocal fold paralysis: aetiology and outcomes. J Laryngol Otol. 2006;120(1):38–41.
• Zuniga SA, Ebersole B, Jamal N. Utility of Eating Assessment Tool-10 in predicting aspiration in patients with unilateral vocal fold paralysis. Otolaryngol Head Neck Surg. 2018;159(1):92–6 Salient paper on utility of patient completed questionnaire in the setting of aspiration resulting from unilateral vocal fold paralysis.
Puccinelli C, Modzeski MC, Orbelo D, Ekbom DC. Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery. Am J Otolaryngol. 2018;39(2):175–9.
Graboyes EM, Bradley JP, Meyers BF, Nussenbaum B. Efficacy and safety of acute injection laryngoplasty for vocal cord paralysis following thoracic surgery. Laryngoscope. 2011;121(11):2406–10.
Flint PW, Purcell LL, Cummings CW. Pathophysiology and indications for medialization thyroplasty in patients with dysphagia and aspiration. Otolaryngol Head Neck Surg. 1997;116(3):349–54.
Woodson G. Cricopharyngeal myotomy and arytenoid adduction in the management of combined laryngeal and pharyngeal paralysis. Otolaryngol Head Neck Surg. 1997;116(3):339–43.
Conklin M, Clary MS, Cuadrado EM, Jette ME. Effect of unilateral cordotomy on perception of dysphagia. Ann Otol Rhinol Laryngol. 2020;129(6):536–41.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Christine M. Kim and Karuna Dewan declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical collection on Laryngology: Management of Vocal Cord Paralysis
Rights and permissions
About this article
Cite this article
Kim, C.M., Dewan, K. Vocal Fold Paralysis and Dysphagia. Curr Otorhinolaryngol Rep 9, 101–106 (2021). https://doi.org/10.1007/s40136-021-00332-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40136-021-00332-y