Vocal Fold Paralysis and Laryngeal Reinnervation
Vocal fold paralysis is the loss of movement in one or both vocal folds, usually because the nerve supplying the muscles has been injured. The voice becomes weak or breathy, swallowing can become unsafe, and in bilateral cases breathing itself is affected.
Assoc. Prof. Necati Enver
Founder & Director
The plan depends on more than the diagnosis
The central idea of this program is range. A paralysed vocal fold can be managed in several ways, and the right choice depends on the cause, the time since injury, the patient's age, and what the patient needs their voice to do. A clinic that offers only one technique tends to fit the patient to the technique. We prefer to keep the full range available and match the intervention to the patient.
Your pathway
Remote review or visit
History, reports and any recordings; examination with stroboscopy.
Evaluation
Laryngeal EMG and imaging where they would change the plan.
Plan and timing
The option and the moment, chosen with you: wait, inject, or a definitive procedure.
Treatment
Injection in the clinic, thyroplasty or reinnervation in theatre.
Follow-up
Voice therapy and review as the result develops over months.
Our approach
That range runs from the temporary to the definitive. Injection augmentation can restore a usable voice quickly and buys time when recovery is still possible. Framework surgery repositions the fold for a lasting result. Laryngeal reinnervation reconnects a nerve supply, which can restore tone to the muscle rather than only repositioning the fold, and is considered particularly in younger patients with unilateral paralysis.
Who this program is for
This program is for patients with a paralysed or weak vocal fold after nerve injury: often following thyroid, chest, or neck surgery, after a viral illness, or without an identified cause. Referring surgeons send patients with a new hoarse or breathy voice after an operation. Neurologists send patients whose swallowing has become unsafe. Some patients arrive years after the injury, having lived with a compromised voice, and are candidates for a definitive procedure.
Unilateral and bilateral paralysis
Unilateral paralysis. One vocal fold does not move, so the other can no longer close against it fully. Air escapes during speech: the voice becomes weak, breathy and tiring to use, the cough is less effective, and thin liquids may go the wrong way. Breathing is usually unaffected, and the aim of treatment is to restore closure.
Bilateral paralysis. Both folds are affected and usually rest close to the midline. The voice may be near normal, but the airway between the folds is narrow, which causes noisy breathing, breathlessness on exertion, and at times an urgent airway problem. This is a different and more urgent situation. Treatment aims first at a safe airway, and then at the best balance between breathing, voice and swallowing, using procedures that widen the airway and, in selected patients, selective reinnervation.
How we evaluate
Evaluation begins with a detailed history and examination of the larynx with stroboscopy, which shows the position and movement of each fold and how well they close. Where it would change the plan, laryngeal electromyography (EMG) records the activity of the laryngeal muscles through a fine needle electrode; it helps to separate a nerve injury from a fixed joint and gives information about the likelihood of spontaneous recovery. Imaging is used to look for the cause when none is known. The choice among treatments is made together with the patient, after this assessment.
Treatment options
Injection laryngoplasty. An awake, in-clinic procedure that bulks the paralysed fold so the other can meet it. The effect is immediate and, with most materials, temporary. See Injection Laryngoplasty.
Medialisation thyroplasty. Framework surgery (medialisation laryngoplasty, at times with arytenoid adduction) is performed in theatre, repositioning the fold through a small neck incision while the patient's voice is checked during the operation. See Medialisation Thyroplasty.
Laryngeal reinnervation. Laryngeal reinnervation connects a nearby nerve to the laryngeal muscle supply; the benefit appears gradually over months as the nerve grows, not immediately. See Laryngeal Reinnervation.
Selective reinnervation. In selected patients with bilateral paralysis, selective reinnervation aims to restore nerve supply separately to the muscles that open the airway and those that close it, so that breathing can improve without sacrificing the voice. It is a specialised procedure, offered after careful assessment of each case.
Treatment timing
Timing matters as much as technique. In the first months after an injury the nerve may recover, so a temporary injection is often used to restore a usable voice and protect swallowing without closing off that possibility. When recovery is unlikely, or enough time has passed, a definitive option is considered. Reinnervation relies on the muscle still being able to accept a new nerve supply, which is one reason why we prefer to see patients early, although benefit is also reported in longer-standing cases. We explain which window applies to you.
Evidence and experience
Reinnervation and medialisation are established techniques with a substantial literature. Laryngeal reinnervation itself is performed by only a small number of surgeons worldwide. The director is among them, performs both unilateral and bilateral reinnervation, and teaches the technique as a faculty member of the Rouen Laryngeal Reinnervation Course. That depth of experience is what makes the full range of options, rather than a single default, available here.
What to expect afterwards
Injection augmentation gives an immediate but temporary improvement. Framework surgery gives a lasting result, with a recovery period and the usual surgical risks. Reinnervation asks for patience: months pass before the muscle regains tone, and the degree of recovery varies between patients. We are explicit that no option guarantees a normal voice, and that the aim is a reliable, usable voice matched to what the patient needs.
Second opinion and remote case review
Patients are sometimes told that nothing more can be done, or are offered a single option. If you have a plan and want an independent view, we can review your reports and examination recordings remotely before you decide whether to travel. See Second Opinion / Remote Case Review.
Medically reviewed by
Associate Professor Necati Enver, MD
Laryngologist · Founder and Director, Istanbul Voice Center · Reviewed September 2026
General information only. It does not replace an individual assessment. Medical disclaimer
Frequently asked questions
Can a paralysed vocal fold recover on its own?
Some do, particularly in the first months after a nerve injury. This is why temporary injection augmentation is often used to restore a usable voice while spontaneous recovery is still possible. Whether to wait depends on the cause and the time elapsed.
What is laryngeal reinnervation?
Laryngeal reinnervation is an operation that connects a nearby nerve to the nerve supply of the laryngeal muscles, restoring tone to the paralysed vocal fold rather than only repositioning it. The benefit appears gradually over months as the nerve grows.
Is reinnervation better than injection or framework surgery?
No single option suits everyone. Injection works quickly but is temporary, framework surgery gives a lasting reposition, and reinnervation can restore muscle tone but requires patience. The right choice depends on the cause, the time since injury, the patient's age, and what the voice needs to do.
How long does recovery take after laryngeal reinnervation?
Months rather than weeks. The muscle regains tone gradually as the nerve grows, and the degree of recovery varies between patients.
What is laryngeal EMG, and do I need it?
Laryngeal electromyography records the electrical activity of the laryngeal muscles through a fine needle electrode. It helps to separate a nerve injury from a fixed joint and gives information about the likelihood of recovery. It is not needed in every case; we recommend it when the result would change the plan.
Can I have my case reviewed before travelling?
Yes. Send your reports and any recordings of a previous laryngeal examination. We review them and tell you what we would advise, and whether an in-person visit is worthwhile, before you book travel.
Discuss a vocal fold paralysis case
Send a short history and any stroboscopy or laryngoscopy recordings. We reply with our view on the options and the timing.