Behavioral Readjustment Therapy versus Vocal Fold Injection in the Management of Swallowing Disorders in Cases of Unilateral Vocal Fold Paralysis

Abstract

Background: Unilateral vocal fold immobility (UVFI) is the most prevalent neurological disease affecting the larynx.
Objective: This work aimed to evaluate management of oropharyngeal dysphagia in cases of unilateral vocal fold
paralysis (UVFP) by either behavioral readjustment therapy (BRAT) or vocal fold injection (VFI) to provide the best
management technique regarding safety and effectiveness in these patients.
Methods: This study was carried out on 20 consecutive candidates of both sexes with vocal fold immobility and
dysphagia for BRAT or VFI. They were aged from 20 to 60 years old, both sexes. Patients were divided randomly into
two equal groups: Group I included odd numbers received BRAT with mean age of 42.3 ± 15.21 years and group II that
included even numbers received VFI with mean age of 45.1 ± 12.56.
Results: The glottic gap was significantly better in one week and three months follow-up for injection group than
behavioral group. The presence of the residue one week post intervention showed non-significant difference between
both groups. Penetration aspiration scale (PAS) after one week and 3 months of intervention for fluids showed a
significant difference between both groups but PAS for semisolids and solids showed no significant difference between
them. Food consistency was affected and choking of fluid showed a significant difference in both groups.
Conclusions: Injection laryngoplasty (IL) and BRAT could improve oropharyngeal dysphagia in patients with unilateral
VFP. IL improved the glottal closure, therefore it improved airway protection and increased cough power, so it helps to
prevent aspiration. BRAT improved motor power and motor control of swallowing in oropharyngeal phase, improved
impaired sensation, improved bolus flow, and decreased the patient’s symptoms.