Voice Therapy as a Complementary Approach to Phonosurgery for Unilateral Vocal Fold Paralysis

Objectives: To determine whether vocal function exercises (VFE) could serve as an adjunct therapy for patients with unilateral vocal fold paralysis (UVFP) who remained unsatisfied with their postoperative voices following reinnervation surgeries.

Study Design: Retrospective

Methods: Medical records of patients with UVFP who underwent laryngeal reinnervation were reviewed. Patients were divided into two groups based on their preferences: a VFE group and a control group without voice therapy. The effects of VFE were assessed by examining changes in vocal fold vibration (regularity, amplitude, glottal gap), aerodynamic measurements (maximum phonation time [MPT] and mean airflow rate [MFR]), perceptual evaluations (GRBAS scale), acoustic parameters (pitch range, pitch perturbation and amplitude perturbation quotients [PPQ, APQ], noise-to-harmonics ratio [NHR]), and subjective assessments using the Voice Handicap Index-10 (VHI-10). Phonatory function was also compared between the two groups at three time points: before reinnervation surgery, before VFE, and after VFE.

Results: Thirty patients were enrolled (11 men, 19 women). Eight constituted the VFE group, while 22 served as controls. In the VFE group, several parameters (amplitude, MPT, MFR, pitch range, APQ, and NHR) did not show significant improvement after surgery, whereas the control group demonstrated significant improvement in all parameters. However, following VFE, amplitude, glottal gap, MFR, the B score, pitch range, and PPQ showed significant improvement in the VFE group, while the control group only improved significantly in VHI-10 during the corresponding period. At the final time point, significant differences were observed between the two groups in G and B scores and VHI-10.

Conclusions: VFE may be a useful adjunct treatment for patients with UVFP who remain dissatisfied with their voice after reinnervation surgery. However, phonatory function after VFE may not fully match the level achieved by patients who are satisfied with their postoperative voices.

Learning Outcomes: Participants will gain an understanding of the effectiveness of Vocal Function Exercises (VFE) for unilateral vocal fold paralysis in cases uncomplicated by muscle tension dysphonia.