title: SURGICAL MANAGEMENT OF VOCAL CORD PARALYSIS: THE NEED FOR CAREFUL PATIENT SELECTION.
abstract: BACKGROUND
  Vocal cord paralysis is one of the challenging laryngeal clinical entities confronting the Laryngologist and indeed, the Phono-surgeon. The ability to maintain an effective balance between voice and airway function to ensure good quality of life requires expertise. This study is therefore designed to highlight our experience on surgical management of vocal cord paralysis.
  
  
  METHODS
  Clinical notes of all patients that met the inclusion criteria for this study on vocal cord paralysis over a ten-year period were analysed. Data was generated from patients' case files retrieved using standard codes according to the International Classification of Diseases (ICD-10).
  
  
  RESULTS
  From the 7,941 new ENT cases seen, 26 patients had vocal cord paralysis (VCP) giving a prevalence of 0.3%. The male to female ratio was 1: 4.2 with a mean age of 45.7years ± 6.3. Their ages ranged from 21-80 years. Thyroidectomy was the main causal factor in 46.2% while idiopathic causes was documented in 23.1%. Twenty-three patients (88.5%) had unilateral VCP from which 21(91.3%) were abductor paralysis. The ratio of Left: Right VCP was 3:1. All the 3 bilateral cases were abductor paralysis. Neurotropic agents only, were effective in cases of unilateral VCP. However, in those with bilateral paralysis, two had tracheostomy only, while the third had a laryngo-fissure, arytenoidoplasty and endo-laryngeal stenting in addition. All were successfully decannulated with good voice quality.
  
  
  CONCLUSIONS
  With these observations, we suggest the choice of appropriate surgical technique, timing and careful patient selection in order to preserve voice, curtail operative sequelae and achieve good quality of life (QoL) which is the overall management strategy, be borne in mind.
authors.affiliation: Department of Oto-rhinolaryngology, University College Hospital, College of Medicine, University of Ibadan, PMB 5116, Ibadan, Oyo State, Nigeria.
authors.forename: D D
authors.initials: DD
authors.lastname: Kokong
authors.affiliation: Department of Oto-rhinolaryngology, University College Hospital, College of Medicine, University of Ibadan, PMB 5116, Ibadan, Oyo State, Nigeria.
authors.forename: A A
authors.initials: AA
authors.lastname: Adoga
authors.affiliation: Department of Oto-rhinolaryngology, University College Hospital, College of Medicine, University of Ibadan, PMB 5116, Ibadan, Oyo State, Nigeria.
authors.forename: A
authors.initials: A
authors.lastname: Bakari
authors.affiliation: Department of Oto-rhinolaryngology, University College Hospital, College of Medicine, University of Ibadan, PMB 5116, Ibadan, Oyo State, Nigeria.
authors.forename: P O
authors.initials: PO
authors.lastname: Okundia
authors.affiliation: Department of Oto-rhinolaryngology, University College Hospital, College of Medicine, University of Ibadan, PMB 5116, Ibadan, Oyo State, Nigeria.
authors.forename: P A
authors.initials: PA
authors.lastname: Onakoya
authors.affiliation: Department of Oto-rhinolaryngology, University College Hospital, College of Medicine, University of Ibadan, PMB 5116, Ibadan, Oyo State, Nigeria.
authors.forename: Ogb
authors.initials: O
authors.lastname: Nwaorgu
keywords: Appropriate surgical technique; Timing; Vocal cord paralysis