The Laryngoscope Lippincott Williams & Wilkins © 2008 The American Laryngological, Rhinological and Otological Society, Inc. Quality of Life Measures and Predictors for Adults With Unilateral Vocal Cord Paralysis Tuan-Jen Fang, MD; Hsueh-Yu Li, MD; Richard E. Gliklich, MD; Ya-Hui Chen, MHA; Pa-Chun Wang, MD, MSc; Hsiu-Feng Chuang, MS Objective/Hypothesis: To investigate the quality of life (QoLF) status of Taiwanese adults with unilateral vocal cord paralysis (UVCP). Study Design: A prospective, QoLF survey in a tertiary referral voice center. Methods: Fifty-five consecutive UVCP patients were evaluated with Medical Outcome Study Short Form-36 (SF-36) Health Survey and the voice out- come survey at entry. Results: UVCP patients have significantly lower scores in all eight SF-36 subscales (P  .05) than do normative Taiwan adult population, particularly in role functioning-physical problems, social functioning, and role functioning-emotional problems. Shimmer parameter is a robust and consistent predictor for bodily pain ( = -20.8), role functioning-emotional problems ( =-27.9), and social functioning ( =-20) general health dimen- sions. Shimmer is also predictive of UVCP-related total voice outcome survey score ( =-8.6, P  .05). Conclusions: UVCP can seriously compromise pho- nation, swallowing, and social functions; thus signifi- cantly impacting a patient’s general health status. Voice physiological function is also a QoLF outcome indicator. Key Words: Unilateral vocal cord paralysis, health status, quality of life. Laryngoscope, 118:1837–1841, 2008 INTRODUCTION The ability to use one’s voice is believed to have great impact not only on physical but also on a patient’s mental and social status. A nice voice will make one more attrac- tive and self-confidant, and raise self-esteem. However, in previous quality of life (QoLF) research, the severity of dysphonia did not show a positive correlation with the patients’ QoLF. 1,2 Aside from using traditional physiolog- ical parameters, it is also important to understand pa- tients’ QoLF from their own perspective. Unilateral vocal cord paralysis (UVCP) is a frequent cause of dysphonia and dysphagia. It is caused by damage to the course of laryngeal nerves. Even though laryngeal nerves run deep in the neck and upper chest, they can be damaged by diseases of the surrounding structures or by iatrogenic manipulation during the disease management processes. The voice of UVCP sounds breathy and weak, and patients frequently complain about straining dyspnea while talking. Some also complained of aspiration or chok- ing when drinking. Some cases of UVCP can get a near normal laryngeal function by voice therapy. In cases of uncompensated UVCP after speech therapy, to medialize the paralyzed cord by a surgical correction is considered. The most com- mon procedures are type I thyroplasty and injection aug- mentation laryngoplasty. The goal of this therapy is to make the edge of the paralyzed vocal fold closer to the midline to facilitate glottal closure during phonation and swallowing. However, the indication and proper timing for such aggressive procedure is still controversial, 3 because it is sometimes difficult to predict whether an injured recurrent nerve will recover or not. Generally, it is recom- mended to wait at least 6 months 4 after the first symp- toms occur. The problems of voice and swallowing usually lead patients to high frustration levels and difficult com- munication. A successful treatment often aims at improv- ing QoLF rather than improving the voice quality. In patients of pulmonary dysfunction or issues of being bed ridden, an earlier surgical medialization to improve the QoLF is necessary because pulmonary clearance becomes better because of more efficient coughing. 4 As so, a com- prehensive QoLF measurement in patient’s of UVCP be- fore treatment is necessary to understand the real func- tional status of a patient. The most common way to evaluate voice quality percep- tually is by applying the grade, roughness, breath-related voice, asthenia, and strain, or roughness, breathiness, and From the Department of Otolaryngology (T.-J.F.), Chang Gung Me- morial Hospital, Keelung, Taiwan; School of Medicine (T.-J.F., H.-Y.L.), Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology (H.-Y.L.), Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Otolaryngology (R.E.G.), Massachusetts Eye and Ear Infirmary, Boston, MA, U.S.A.; Department of Otology and Laryngology (R.E.G.), Harvard Medical School, Boston, Massachusetts, U.S.A.; Cathay Medical Research Institute (Y.-H.C.), Taipei, Taiwan; Department of Otolaryngology (P.-C.W.), Cathay General Hospital, Taipei, Taiwan; School of Medicine (P.-C.W.), Fu Jen Catholic University, Taipei, Taiwan; School of Public Health (P.-C.W.), China Medical University, Taichung, Taiwan; and Department of Otolaryngology (H.-F.C.), Chang-Gung Memorial Hospital, Keelung, Taiwan. Editor’s Note: This Manuscript was accepted for publication May 1, 2008. Send correspondence to Pa-Chun Wang, MD, MSc, Department of Otolaryngology, Head and Neck Surgery, Cathay General Hospital, 280 Sec. 4 Jen-Ai Rd, 106 Taipei, Taiwan. E-mail: drtony@tpts4.seed.net.tw DOI: 10.1097/MLG.0b013e31817e7431 Laryngoscope 118: October 2008 Fang et al.: QoLF in Unilateral Vocal Cord Paralysis Patients 1837