Vocal cord medialisation

This leaflet is for patients who are due to undergo a vocal cord medialisation procedure in the outpatient (clinic) setting.

About the vocal cord medialisation procedure

A vocal cord medialisation procedure involves an injection into one of your vocal cords. These injections are offered when you have one vocal cord that is not moving properly. The result is that your vocal cords cannot close normally to enable you to produce a clear voice. You may also experience difficulties with swallowing.

The injection will move the vocal cord which doesn’t work nearer to the one that does, so that there is a smaller gap between them when you speak or swallow. This is done by injecting a filler paste into the vocal cord.

Information about your procedure

Some patients who require investigations into their throat may need to be put to sleep for this procedure (general anaesthetic). However, you have been offered this procedure under local anaesthetic which avoids the need for admission to hospital and reduces the risk to you by avoiding a general anaesthetic. The doctor will be able to examine you in the outpatient clinic using a small flexible telescope passed through your nose and down into your throat.

About your appointment

Before your appointment

• Make sure you inform the medical or nursing staff about any allergies that you have.
• Unless informed otherwise, you can as normal eat, drink and take any medications (apart from blood thinners – see below).
• Important: If you take blood thinning tablets such as warfarin or clopidogrel, make sure you let the team know in advance as they may want you to stop this medication for two to five days before your procedure.
• Plan to rest your voice after your injection procedure – you will need to rest your voice completely for one day, including no talking or whispering.
• Warn your friends and family that you will not be able to speak for a day after the procedure.
• Advise your employer that you will need to take time off work if necessary.
• Have a pen and pad or mobile device available to write things down, or have someone stay with you who can help with your communication during this time.

What happens at my appointment?

The procedure is carried out in the outpatient department. You will be awake the entire time. The doctor will explain the procedure to you and ask for your consent to continue.

• A local anaesthetic spray will be sprayed into your nose and throat. This takes a few minutes to take effect.
• A flexible telescope will then be placed in your nose and passed into your throat, usually by a speech and language therapist or an ENT (ear, nose and throat) doctor.
• You will be able to breathe, swallow and cough quite normally during the investigation, although your throat may feel numb.
• A local anaesthetic injection will then be made into your voice box (larynx) where the vocal cords sit.
• Once this has taken effect another injection will be made into your voice box to add the filler to the vocal cord that is not working correctly.

How long will the procedure take?

It takes five to 10 minutes for the spray to take effect. Generally, the procedure itself takes approximately 15 to 25 minutes. Overall, appointments will last approximately 30 to 45 minutes.

Does the procedure hurt?

The doctor sprays both the nose and throat with a solution of local anaesthetic, which makes the area numb. Patients may feel some pressure during the procedure but will rarely experience discomfort. If you do experience any discomfort during the procedure, make the doctor performing it aware of this.

Can I go home straight away?

The advantage of treatment in the outpatient department is that you do not require hospital admission. After the procedure you will be observed for a few minutes and asked to remain in the department for a short period of time to ensure that you feel comfortable.

There are no restrictions to driving or operating machinery after the procedure when it is performed using a local anaesthetic.

After the procedure

Your nose and throat will remain numb for a while after the procedure which may make you less aware of the temperature of food and drink, so do not eat or drink anything hot for two hours after the procedure.

You may have some mild discomfort in the throat or nose for a few hours. You can use paracetamol to help with this.

We advise you to rest your voice for a minimum of 24 hours after the procedure – do not talk or whisper. Use alternative means of communication as mentioned above.

If you are using anticoagulation medication (such as warfarin) you should resume its use as directed by your GP or anticoagulant clinic.

The ENT doctor will book you to a follow-up clinic for a few weeks’ time.

If you have any questions or concerns before then, you may contact the ENT department via the hospital Contact Centre on 01223 245151.

Important: If you experience any of the following symptoms, call the hospital or go straight to A&E:

• breathing problems such as shortness of breath or rapid breathing
• spitting up bright red blood
• temperature over 38 degrees Celcius
• chest pain