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How is bilateral recurrent laryngeal nerve injury treated?

Nov 28, 2025 Source: Cainiu Health
Dr. Wang Lei
Introduction
Treatment for bilateral recurrent laryngeal nerve injury commonly includes conservative observation, pharmacological supportive therapy, voice training, surgical exploration and repair, and tracheotomy. Conservative management is suitable for patients with mild injuries, involving close monitoring of breathing and voice production, while waiting for spontaneous nerve recovery. During this period, excessive voice use should be avoided and throat irritation minimized. Most patients can regain partial function within several months.

Treatment for bilateral recurrent laryngeal nerve injury generally includes conservative observation, medication-assisted therapy, voice training, surgical exploration and repair, and tracheotomy. Detailed analysis is as follows:

1. Conservative observation: Suitable for patients with mild injuries. Close monitoring of breathing and voice production is conducted while waiting for spontaneous nerve recovery. Patients should avoid excessive voice use and reduce pharyngeal irritation during this period; most can regain partial function within several months.

2. Medication-assisted therapy: Use mecobalamin tablets to nourish nerves and promote metabolism, dexamethasone tablets to reduce nerve edema, and vitamin B1 tablets to supplement nutrition. These medications should be taken according to a prescribed course to support nerve recovery.

3. Voice training therapy: After initial recovery of nerve function, professional rehabilitation therapists guide vocal exercises to adjust breathing and phonation techniques, improving hoarseness and difficulty speaking. Long-term adherence is required to consolidate therapeutic effects.

4. Surgical exploration and repair: Indicated for patients with nerve transection or severe compression. Early surgical exploration followed by nerve anastomosis or decompression is recommended. Postoperative rehabilitation training helps improve the success rate of nerve repair.

5. Tracheotomy: Used in patients with severe respiratory distress or laryngeal obstruction. The procedure involves creating an artificial airway by opening the trachea to ensure breathing. After symptom relief, the need for decannulation is evaluated. This is considered an emergency, transitional measure.

Immediate medical evaluation is necessary upon onset of symptoms to determine injury severity. During treatment, avoid vigorous coughing and excessive voice use, and maintain airway patency. Regular laryngoscopy follow-ups are essential to monitor recovery, and prompt medical attention should be sought if breathing difficulties worsen.

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