Unilateral vocal fold paralysis (UVFP) is an increasingly common and debilitating neurological condition caused by injury to one recurrent laryngeal nerve. Increased prevalence of head, neck, spine and cardiothoracic surgeries has increased the population at risk for UVFP; these procedures account for 50% of UVFP cases. UVFP complicates up to 15% of thyroidectomies and 11% anterior spine procedures, respectively. In recent decades, these procedures have increased threefold and eightfold, with a corresponding rise in UVFP incidence. UVFP can have debilitating quality of life consequences that include disordered communication, swallowing and breathing, substantial work productivity losses, and decreased psychosocial function resulting in anxiety, isolation, and fear. Treatments for UVFP vary widely, because the degree of spontaneous recovery and timing of intervention vary with the severity of neurological injury. Patients benefit from some interventions, but the optimal type and timing remain undetermined because of insufficient high-quality comparative evidence.
The CoPE PROM is designed to give clinicians a guide to track symptoms and treatment effectiveness over time. It is also intended to act as a primary end point in clinical trials comparing the effectiveness and durability of treatments including behavioral (speech therapy), temporary (e.g., injection augmentation), and permanent surgical treatments for UVFP. We established the reliability and validity of the PRO measure in a large, nationally representative sample of adult patients with UVFP from a multicenter consortium of 34 voice centers that treat UVFP, called the CoPE (Vocal Cord Paralysis Experience) Collaborative.