Alison Learn, MD, Maisie Shindo, MD, Daniel Kempler, PhD

Very little information is available in the literature on long-term changes in the vocal folds and the voice following medialization procedures for unilateral laryngeal paralysis. Most reports only evaluated the results of thyroplasty (TP) or Teflon injection, and follow-up was limited in these studies. In this study, the long-term changes in the voice and effects on the vocal folds of 30 medialization procedures - 13 by fat injection (FI), 11 by TP, and 6 by arytenoid adduction (AA) - were chronologically evaluated at 1, 3, 6, and 12 months.

Perceptual voice ratings and video stroboscopic evaluations were made by 3 unbiased judges. Breathiness either completely resolved or significantly improved in all 3 groups. Three of the F1 patients developed moderate breathiness after 3 months. Most of the patients in the F1 group had mild vocal roughness, while all patients who underwent TP and AA demonstrated a moderate to severe rough or harsh quality in their voices postoperatively that persisted for 2 to 3 months and improved with time in some patients.

Most F1 patients had normal -appearing vocal cords and fairly symmetric mucosal waves postoperatively, while the TP and AA groups had marked edema, erythema, and a reduced mucosal wave of the ipsilateral cord. Supraventricular hyperfunction, which was present in all patients preoperatively, resolved postoperatively. However, 10% of the patients in the F1 and TP groups had return of hyperfunction after 6 months. The results indicate that FI, TP, and AA improve the vocal intensity considerably; however, patients need to be counseled regarding the quality of the voice in the early postoperative period and the long-term changes.