Objective: To determine the clinical impact of early versus late surgical therapy for new onset unilateral vocal cord paralysis (UVCP) after thoracic surgery. Study design: Patients diagnosed with ne, onset UVCP after esophagectomy, pneumonectomy or pulmonary lobectomy were reviewed to determine the incidence of pneumonia, need for postoperative bronchoscopy and length of stay (LOS). Comparisons were made between patients undergoing early (less than or equal to 4 days after thoracic procedure) versus late rehabilitation (greater than or equal to 5 days after thoracic procedure) of their UVCP with vocal cord tnedialization. Results: Some 86 patients (27 esophagectomies. 43 pneumonectomies and 16 lobectomies) with neck onset UVCP were examined. A total of 32 patients (37.2%) underwent earls vocal cord medialization and 54 (62.8%) underwent late repair. The pneumonia rate for patients undergoing early vocal cord medialization (6.3%) was significantly lower than the rate for focal cord medialization (37.0%, P=0.001, chi(2)). Early medialization patients required fewer postoperative bronchoscopies (mean number of bronchoscopies. 0.26) than late medialization patients (mean bronchoscopies. 0.94. P = 0.013). The median LOS was significantly decreased for early versus late medialization patients in both pneumonectomy (reduction in LOS of 8 days) and lobectomy groups (reduction in LOS of 7 days). Conclusions: Early vocal cord medialization decreases the Pneumonia rate. the requirement for postoperative bronchoscopies and the LOS for patients suffering from new onset UVCP after thoracic surgery. Significance: Consideration should be given to early medialization for new onset UVCP when medically sound. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.