Changing Trends in Management of Bilateral Vocal Fold Paralysis

Bilateral vocal fold immobility describes a condition in which the vocal folds do not move and may result from paralysis of the vocal folds, cricoarytenoid joint fixation and interarytenoid scar 1.Most cases of Bilateral Vocal Fold Paralysis (BVFP) are iatrogenic; surgical injuries (55.5-82.8%),with the majority occurring during thyroidectomies.The remainder of cases may be due to trauma, malignancy, neurologic disease, intubation trauma or idiopathic etiology 2-4.Patients of BVFP usually present with dyspnoea of varying degree or stridor which can be life threatening 3.But their voice quality may be normal due to the typical near-midline position of the vocal folds.If the vocal folds are in a more abducted position, patients may have minimal airway symptoms but a weak, breathy voice quality with dysphagia or aspiration.Presentation of Idiopathic BVFP in adults is of gradual onset respiratory symptoms and diagnosis may be delayed for many years; misdiagnosed and treated as Asthma.In infants, the etiology of BVFP includes birth trauma, neurological, iatrogenic and idiopathic causes 5.Management of BVFP The primary aim of treatment is maintenance of airway and ventilation.BVFP may represent a respiratory emergency often requiring tracheostomy to bypass site of obstruction and ensure an adequate, safe airway.It is often used in the short term while a return of vocal fold mobility is awaited in 6 -12 months time.Several temporary, short term options as well as more permanent treatment options have been proposed for management of BVFP.Short term treatment options include suture lateralization and laryngeal botulinum toxin injection techniques.More permanent treatment options include glottic widening surgeries such as unilateral posterior cordotomy with or without arytenoidectomy or bilateral cordotomy both in adults and pediatric population 6.It has been demonstrated that successful decannulation is possible