Early Versus Late Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

Objectives Unilateral vocal fold paralysis (UVFP) is a condition characterized by the loss of functional movement of one vocal fold resulting in incomplete glottic closure, which compromises essential functions such as phonation, swallowing and coughing. Injection medialization laryngoplasty can temporarily restore glottic closure, improving voice quality and potentially reducing the risk of aspiration. Patients and Methods: A prospective cohort study was conducted from September 2024 to January 2026. Patients with UVFP were divided into early (< 6 months from the onset of paralysis) and late (≥ 6 months). All patients received injection medialization using hyaluronic acid (Perfectha Derm, 20 mg/mL). This was done either under local anaesthesia or under general anaesthesia. Voice assessment was done before injection and at 1 and 6 months post‐injection, including maximum phonation time (MPT), GRBAS, acoustic analysis (jitter, shimmer, HNR) using PRAAT and patient‐reported Arabic Voice Handicap Index (VHI). Results Forty‐eight patients with UVFP were enrolled and divided into early (< 6 months) and late (≥ 6 months) groups. The early injection group showed significantly higher MPT at 1 week and 6 months. Fewer patients required Type I thyroplasty in the early injection group compared to patients who underwent later injection ( p = 0.001). Long‐term acoustic measures were also superior in the early group, indicating better voice quality. Conclusion Early injection laryngoplasty was associated with superior long‐term voice outcomes and a significantly reduced need for permanent medialization surgery compared with late injection. These findings highlight the clinical importance of early intervention in the management of UVFP. Level of Evidence 3.