Vocal cord paralysis is a condition in which you cannot control the movement of the muscles that control your voice. It happens when the nerve impulses to the larynx are interrupted. This generates paralysis in the muscles of the vocal cords.
This paralysis can make it difficult to speak and even breathe. This is because the vocal cords do not just produce sound. They also protect the airways by preventing food, liquids, and even saliva from entering the trachea and causing you to choke.
Possible causes of vocal cord paralysis include nerve damage during a surgical procedure, viral infections, and some types of cancer. Treatment for this condition usually includes a surgical procedure and sometimes voice therapy.
The vocal cords are two flexible bands of muscle tissue found at the entrance to the trachea. When you talk, the bands come together and vibrate to make sounds. The rest of the time, the vocal cords are relaxed in an open position, so you can breathe.
In most cases of vocal cord paralysis, only one vocal cord is paralyzed. Paralysis of both vocal cords is a rare but serious condition. It can cause speech difficulties and significant problems with breathing and swallowing.
Signs and symptoms of vocal cord paralysis include:
panting voice
Hoarseness
noisy breathing
Shortness of breath
loss of vocal tone
Choking or coughing when swallowing food, drinks, or saliva
Needing to take frequent breaths when speaking
inability to speak loudly
Loss of the gag reflex
Unproductive (dry) cough
Frequent throat clearing
If you have unexplained hoarseness for more than 2 to 4 weeks, or if you notice unexplained changes or discomfort in your voice, contact your health care provider.
Some factors that may increase the risk of developing vocal cord paralysis include the following:
Having received throat or chest surgery. People who must undergo thyroid, throat, or upper chest surgery are at increased risk of laryngeal nerve injury. Sometimes the endotracheal tube that is used in surgery or to facilitate breathing if you have a lot of difficulty breathing can cause injury to the laryngeal nerves.
Having a neurological condition. People with certain neurological conditions, such as Parkinson’s disease or multiple sclerosis, are more likely to develop vocal cord weakness or paralysis.
Your health care provider will likely ask about your symptoms and lifestyle, listen to your voice, and ask about how long you’ve had voice problems. To further evaluate voice problems, the following tests can be done:
Laryngoscopy. Your health care provider will examine your vocal cords with a mirror or a thin, flexible tube (known as a laryngoscope or endoscope), or both. You may also have a test called videostrobolaryngoscopy, which uses a special endoscope that has a small camera on the tip or a larger camera attached to the endoscope’s objective eye. These special, high-magnification scopes allow the healthcare provider to view the vocal cords directly or through a video screen to determine their movement and position and whether one or both vocal cords are affected.
Electromyography of the larynx. This test measures electrical currents in the muscles of the larynx. To obtain these measurements, the health care provider typically inserts small needles into the vocal cord muscles through the skin of the neck. This test is not used to guide treatment, but it can give your healthcare provider information about how much you may recover. Also, it is most helpful if it is done between six weeks and six months after the symptoms started.
Blood tests and scans. Since a number of diseases can cause nerve damage, you may need additional tests to identify the cause of the paralysis. Tests may include blood tests, X-rays, and scans for magnetic resonance and computed tomography .
Treatment of vocal cord paralysis depends on the cause, the severity of the symptoms, and the length of time since the onset of symptoms. Treatment may include voice therapy, mass injections, surgery, or a combination of treatments.
In some cases, you can improve without surgical treatment. For this reason, your health care provider may delay permanent surgery for at least a year after the onset of vocal cord paralysis.
However, surgical treatment with various mass injections is usually performed within the first three months of voice loss.
During the waiting period for surgery, your health care provider may recommend voice therapy so you don’t use your voice inappropriately while your nerves heal.
Voice therapy sessions involve exercises or other activities to strengthen the vocal cords, improve breath control during speech, prevent tension in other muscles around the paralyzed vocal cords, and protect the airway when swallowing. Sometimes voice therapy may be the only treatment needed if your vocal cords have become paralyzed in a place that does not require increased volume or additional repositioning.
If the symptoms of vocal cord paralysis do not fully recover on their own, you may be offered surgical treatments to improve your ability to speak and swallow.
Options for surgery include the following:
Injection to give greater volume. Vocal cord nerve palsy will likely cause the vocal cord muscle to become thin and weak. To add mass to a paralyzed vocal cord, a doctor who specializes in disorders of the larynx (laryngologist) may inject the vocal cord with a substance such as body fat, collagen, or another approved filler. This added mass brings the affected vocal cord closer to the middle of the larynx so that the opposite working and moving vocal cord can come into closer contact with the paralyzed cord when you speak, swallow, or cough.
structural implants. Rather than a mass injection, this procedure, known as thyroplasty, medialization laryngoplasty, or laryngeal framework surgery, relies on the use of an implant in the larynx to relocate the vocal cord. Rarely, people who have this surgery may need a second surgery to relocate the implant.
Repositioning of the vocal cords. In this procedure, a surgeon moves a window of tissue on the outside of the larynx inward to push the paralyzed vocal cord toward the middle of the larynx. This allows the intact vocal cord to vibrate better against the paralyzed cord.
Replacement of the damaged nerve (reinnervation). In this surgery, a healthy nerve is moved from a different area of the neck to replace the damaged vocal cord. It may take 6-9 months for your voice to improve. Some health care providers combine this surgery with a mass injection.
Tracheotomy. If the two vocal cords are paralyzed and are in a close position, the airflow will decrease. This causes a lot of trouble breathing and requires a surgical procedure called a tracheostomy. In a tracheostomy, an incision is made in the front of the neck to create a hole in the windpipe. An endotracheal tube is placed, which allows air to be bypassed from the vocal cords.
It is possible that by attaching the vocal cords to another source of electrical stimulation (such as a nerve from another part of the body or a device similar to a cardiac pacemaker) the immobile vocal cords can be restored to opening and closing. Researchers continue to study this and other options.
