Etiology and Management of Bilateral Vocal Fold Paralysis: a Retrospective Cohort Study

Abstract

<h2>Summary</h2><h3>Objectives</h3> Bilateral vocal fold immobility can occur secondary to bilateral nerve injuries, resulting in paralysis of both vocal folds, known as bilateral vocal fold paralysis (BVFP). BVFP can cause airway obstruction and is associated with significant morbidity. Treatment options include tracheotomy, cordotomy, and arytenoidectomy, which are designed to increase the caliber of the upper airway. In the largest BVFP study to date, we set out to review cases of BVFP to better understand the etiologies of paralysis and subsequent surgical interventions. <h3>Methods/Study Design</h3> A retrospective review of patients with BVFP over a 17-year period within a single institution was performed. For each patient included in the study, the etiology of paralysis, simultaneous vs sequential onset of paralysis, subsequent surgeries, and spontaneous recovery were reviewed. Logistic regression was performed to determine whether patient factors predicted tracheotomy or recovery of vocal fold motion. <h3>Results</h3> 86 patients with BVFP followed for greater than 180 days were included in this retrospective cohort study. The majority of patients (84.9%) did not recover any vocal fold motion, while 13 patients (15.1%) recovered motion in at least one vocal fold. Iatrogenic injury was the most common etiology of paralysis. Sixty-seven patients (77.9%) underwent a tracheotomy placement, the most commonly performed procedure. Age, gender, or paralysis progression did not predict whether patients underwent tracheotomy or experienced spontaneous vocal fold motion recovery. <h3>Conclusions</h3> The most common etiology of BVFP was iatrogenic injury during thyroid surgery. A greater number of patients developed simultaneous paralysis of both vocal folds compared to sequential unilateral paralysis. Tracheotomy was the most commonly performed surgery, and the minority of patients were successfully decannulated. This study helps define the etiologies and treatments of patients with BVFP to better describe the patient-related morbidity associated with this condition.