Treatment
Table 5. Discussion Points for a Patient Who Has Voice Changes
After Thyroidectomy
1. Voice changes can be a significant problem after thyroidectomy.
2. Voice changes may consist of hoarseness, weakness, breathiness or difficulty adjusting
volume or pitch.
3. There may be noisy breathing, shortness of breath, rapid fatigue from speaking, or a
persistent cough or choking when swallowing.
4. These voice changes may suggest a weakness of a vocal fold.
5. This problem may or may not improve on its own. The voice may stabilize in a few months,
but laryngeal nerves may take over a year to completely heal, and may never fully recover.
6. Any voice change should be discussed with a physician.
7. There are options to improve the voice. Some data suggest that early treatment helps
improve long-term voice outcome.
8. Treatments range from noninvasive voice therapy to operations. An otolaryngologist is best
suited to recommend the best treatment for each inividual circumstance.
Table 6. Rehabilitative Options for Unilateral VF Paralysis
(treatment and procedures are typically performed for improving voice
and/or swallowing)
Procedure Effect Benefit Notes
Voice therapy
by a speech
language
pathologist
Temporary
or permanent
improvement
Adjustment and
compensation for
altered laryngeal
physiolog y
• Exercises to improve the voice
and/or swallowing
• Noninvasive treatment
Injection
laryngoplasty—
injection of
material into
the VF
a
Temporary
(typically
months)
Restores VF
position and bulk
• Can be repeated when the
injection material disappears
• Often can be performed in
the office, but may also be
performed in the operating room
Framework
procedures—
operations to
improve VF
position
Permanent
(some consider
potentially
reversible)
Restores VF
position
• Near immediate restoration of
voice
• Performed in the operating room
and requires a neck incision
Reinnervation—
an operation
to improve VF
position
Permanent • Restores VF
position and
bulk
• True restoration
of physiologic
reinnervation is
not achievable
• The final surgical outcome can
take up to a year
• A VF injection is typically
performed at the same time to
rehabilitate voice during this
healing period
• Performed in the operating room
and requires a neck incision
a
Commonly injected agents include hyaluronic acid gels, autologous fat, human or bovine collagen,
micronized human dermis, methylcellulose gel, and calcium hydroxyapatite paste. Many of these products
are marketed as dermal fillers and used off-label in the larynx.
