Bilateral vocal fold immobility following head and neck radiotherapy: an institutional review

OBJECTIVES: Bilateral vocal fold immobility is a rare, often delayed complication of head and neck radiotherapy that is not well described in the literature. This study aimed to characterise its timing and clinical course. METHODS: Patients from 2016 to 2024 with prior head and neck radiotherapy, a diagnosis of bilateral vocal fold immobility and no residual disease were reviewed. Data included demographics, tumour site, radiotherapy type/dose, chemotherapy, interval to bilateral vocal fold immobility, airway intervention, nutrition route and mobility recovery. RESULTS: Twelve patients (10 male, 2 female; median age 65.8 years) were identified. Glottic (4, 33.3 per cent) and nasopharyngeal (3, 25 per cent) tumours were the most common. Most (11, 91.7 per cent) received intensity-modulated radiotherapy (median dose 68 Gy); eight had chemoradiation. Median time to bilateral vocal fold immobility was 7.5 years. Seven required tracheostomy (two decannulated); eight needed percutaneous gastric tubes. No patients recovered mobility. CONCLUSION: Bilateral vocal fold immobility following radiotherapy is rare, delayed, often irreversible, and frequently requires tracheostomy and enteral nutrition.