Vocal Fold Paralysis and Dysphagia

Abstract

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. 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. Patients with UVFP are more likely to develop aspiration pneumonia. Patient outcomes are best with early intervention restoring glottic competence.