We appreciate Dr. Crumley’s comments and would like to address some of his concerns.

First, Dr. Crumley states that most otolaryngologists would take issue with our statement that a conservative approach to treatment of unilateral vocal fold paralysis is indicated during the first few months post paralysis. It is our observation that most otolaryngologists still agree that it is appropriate to wait 9-12 months or longer from the onset of paralysis, before attempting any surgical treatment. In the first two paragraphs on page 45, we make it clear that the voice therapy approach was advocated during this waiting period as “. . . an initial approach to voice management.” This position is also stated in the abstract and again in the discussion section. An informal survey, conducted since receipt of the letter by Crumley, indicates that 22 laryngologists from 14 states advocate waiting 9-12 months before attempting surgical intervention. Further, the literature in otolaryngology and in speech-pathology agrees that a waiting period is appropriate. For example, LaBlance, Maves, Cobb, and Eitnier (1991) waited an average of 23.5 months from cord paralysis to perform successful thyroplasty resulting in voice improvement.