Vocal cord injection in the treatment of acute and chronic aspiration

The problem of maintenance of proper tracheobronchial toilet is frequently a determining factor in the morbidity and mortality of patients with vocal cord paralysis. Aspiration from an incompetent glottis can cause pneumonitis and its attendant complications. Standard management of tracheobronchial toilet in patients with vocal cord paralysis has involved direct or indirect suctioning of the trachea; however, only the symptoms and not the anatomic defect are treated by these measures. Largely due to the work of Arnold and Lewy, the technique of vocal cord injection has been advocated as a method of correcting the anatomic deficiencies in patients with vocal cord paralysis, and has been advocated in the past to prevent recurrent and chronic aspiration. This study has shown that vocal cord injection increases the ability to maintain maximum peak intraluminal air pressures following injection. It has also shown that there is an increased ability to maintain air flow by glottic closure following injection. Eleven patients were studied, each of whom has been evaluated separately in this paper. The use of vocal cord injection should be more widely used by otolaryngologists and chest disease specialists for treatment of physiologic problems as well as correcting vocal disturbances.