Application of a Stepwise Treatment Protocol in the Closed-Loop Management of Unilateral Vocal Cord Paralysis...

To clarify the essence and value of a stepwise treatment plan and explore its application in closed-loop management for patients with unilateral vocal cord paralysis after thyroid surgery.

A self-controlled design was adopted, in which each patient served as their own control, allowing for intraindividual comparison of all voice function indicators measured before and after intervention. Thirty-nine patients with unilateral vocal cord paralysis after thyroid surgery who were treated between February 2023 and May 2025 were included. Patients underwent weekly voice resistance training for 8 weeks based on laryngeal relaxation. Autologous fat grafting was performed for patients whose compensation was inadequate after training. Voice Handicap Index (VHI), Global Rating of Voice-Related Symptoms and Appearance (GRBAS), computerized voice analysis, maximum phonation time (MPT), and stroboscopy were assessed before and after training/surgery to compare differences in these metrics.

After training, patients showed reduced VHI scores, GRBAS ratings, fundamental frequency jitter, and shimmer; increased vocal intensity and MPT; and no statistically significant difference in mean fundamental frequency. Fluoroscopic laryngoscopy revealed good compensatory vocal cord closure on the unaffected side in 71.79% (28/39) of the patients who achieved glottic closure. Six patients showed inadequate compensation, and five patients requested surgical intervention because of poor training outcomes. Postoperatively, the VHI scores decreased in all five patients, and the GRBAS ratings and shimmer decreased, whereas the vocal intensity and MPT improved compared with the preoperative values. The mean fundamental frequency and fundamental frequency jitter did not significantly differ, and all five patients achieved complete glottic closure.

The proposed stepwise treatment protocol overcomes the limitations of monotherapy for unilateral vocal cord paralysis after thyroid surgery. By integrating standardized voice training with individualized surgical intervention, it achieves tiered treatment and closed-loop management, systematically improving patients' voice function and offering a new comprehensive closed-loop management strategy for this patient population.