Vocal cord paralysis: Causes, diagnosis, and treatment

Vocal cord paralysis, also known as vocal cord paresis, is the inability of one or both vocal cords (vocal folds) to move.

It can greatly impact on the daily life of the sufferer, including employment, choice of job, social interactions and leisure time activities.

In this article, we will look at the causes, diagnosis, and treatment of vocal cord paresis.

Fast facts on vocal cord paralysis

Here are some key points about vocal cord paralysis. More detail and supporting information is in the main article.

Vocal cord paralysis is caused by nerve damage

The disease can cause a number of problems including the inability to speak

Coughs and sneezes may become ineffective, allowing a build-up of fluids and possible infections

Voice therapy can help in certain circumstances

Sometimes, no underlying cause for the condition can be found.

What is vocal cord paralysis?

[Vocal cord and trachea]
Vocal cord paralysis normally only affects one of the vocal cords.

The condition is caused by damage to nerves going to the vocal cord – the nerve impulses in the larynx (voice box) are interrupted, resulting in paralysis of the vocal cord muscles. It can also be caused by brain damage.

Patients with vocal paralysis typically experience hoarseness, vocal fatigue, mild to severe reduction in speech volume, a pain in the throat when speaking, and swallowing things down the wrong way and choking.

The vocal cords, as well as allowing us to produce utterances (speak, etc.) also protect the airway, preventing food, drink, and saliva from entering the trachea (windpipe). In extreme cases, the resultant choking can lead to death.

Individuals with vocal cord paralysis may find the effectiveness of coughing, swallowing or sneezing in removing laryngeal area waste is undermined reduced vocal cord mobility. This may result in accumulations in the area, allowing for bacterial and viral colonization, and subsequent infections and throat discomfort.

Treatment for vocal cord paralysis

Vocal cord paralysis treatment depends on several factors, including what caused it, how severe symptoms are, and how long they have been present. The patient may be advised to have voice therapy, surgery, or both.

Voice therapy

Voice therapy is the equivalent of physical therapy for large muscle paralysis. The therapist asks the patient to do special exercise and some other activities to strengthen their vocal cords, improve their breath and control while speaking, prevent unusual tensions in other muscles near the affected vocal cord(s), and protect the airway from liquids and solids.

Surgery

If the patient does not recover completely with voice therapy, the doctor may recommend surgical intervention. There are a number of surgical options:

Bulk injection – the vocal cord muscle will most likely be weak due to paralysis of the nerve. The otolaryngologist (ear, nose, and throat specialist doctor) may inject fat, collagen or some filler into the vocal cord.

The extra bulk brings the vocal cord nearer to the middle of the larynx (voice box), making it easier for the opposite cord muscle to move effectively when the patient coughs, swallows or speaks.

Phonosurgery (vocal cord repositioning) – this operation repositions and/or reshapes the vocal fold (cord) to improve voice functions.

Tracheotomy – if both vocal folds (cords) are affected and very close to each other, breathing will be more difficult because of decreased air flow.

The doctor makes an incision (cut) in front of the neck, and an opening is created into the trachea (windpipe). A breathing tube is inserted so that the patient can breathe with air bypassing the paralyzed vocal cords.

Put simply, the patient breathes through a hole in the neck because the opening in the larynx is too small for proper breathing.

[Brain scans]
Some neurological conditions – multiple sclerosis, Parkinson’s disease – increase the risk of vocal cord paralysis.

Doctors do not always know what causes vocal cord paralysis, but the following are known causes:

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