For a patient with idiopathic unilateral vocal fold paralysis and a large glottal gap, what is the most appropriate initial treatment?

In cases of idiopathic unilateral vocal fold paralysis accompanied by a large glottal gap, the initial treatment typically focuses on immediately improving vocal function and closing the glottal gap. Injection augmentation is a commonly recommended approach because it directly addresses the lack of bulk in the paralyzed vocal fold, thereby allowing for better approximation with the healthy fold during phonation. This creates a better seal during speech and can significantly improve vocal quality for the patient.

Following injection augmentation, voice therapy plays a crucial role in helping patients adapt to the changes in their vocal mechanism, optimize their voice use, and enhance their overall communication effectiveness. Therefore, combining both treatments—initially performing injection augmentation to manage the structural problem and then utilizing voice therapy to improve functional outcomes—is considered an optimal approach for treating this condition effectively.

Other treatment options could involve just voice therapy or surgical interventions like thyroplasty, but they may not provide the immediate functional improvement coupled with tailored support needed for the patient in this scenario. Voice therapy alone may not sufficiently address the structural deficit, and direct surgical measures without prior augmentation might not yield as favorable initial communication results, making the combined approach the most comprehensive option.