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Vocal Cord Paralysis
On this page:
- What is vocal cord paralysis?
- What causes vocal cord paralysis?
- What are the symptoms?
- How is vocal cord paralysis diagnosed?
- How is vocal cord paralysis treated?
- Where can I get help?
- Where can I get more information?
What is vocal cord paralysis?
Vocal cord paralysis is a voice disorder that occurs when one or both of the vocal cords (or vocal folds) do not open or close properly. Vocal cord paralysis is an uncommon disorder, and symptoms can range from mild to life threatening.
The vocal cords are two elastic bands of muscle tissue located in the larynx (voice box) directly above the trachea (windpipe). The vocal cords produce voice when air held in the lungs is released and passed through the closed vocal cords, causing them to vibrate. When a person is not speaking, the vocal cords remain apart to allow the person to breathe.
What causes vocal cord paralysis?
Vocal cord paralysis may be caused by head trauma, a neurologic insult such as a stroke, a neck injury, lung, thyroid, chest or heart surgery, a tumor pressing on a nerve, or a viral infection. Vocal cord paralysis is an uncommon problem affecting voice production. People with certain neurologic conditions, such as multiple sclerosis or Parkinson's disease may experience vocal cord paralysis. In many cases, however, the cause is unknown.
What are the symptoms?
People who have vocal cord paralysis experience abnormal voice changes, changes in voice quality, and discomfort from vocal straining. For example, if only one vocal cord is damaged, the voice is usually hoarse or breathy. Changes in voice quality, such as loss of volume or pitch, may also be noticeable.
Someone who has vocal cord paralysis often has difficulty swallowing and coughing because food or liquids slip into the trachea and lungs. This happens because the paralyzed cord or cords remain open, leaving the airway passage and the lungs unprotected.
Damage to both vocal cords, although rare, usually causes people to have difficulty breathing because the air passage through the trachea is blocked.
Patricia Taft, M.S., preparing to perform videostroboscopy
How is vocal cord paralysis diagnosed?
Vocal cord paralysis is usually diagnosed by an otolaryngologist-a doctor who specializes in ear, nose, and throat disorders. Noting the symptoms the patient has experienced, the otolaryngologist will ask how and when the voice problems started in order to help determine their cause. Next, the otolaryngologist listens carefully to the patient's voice to identify breathiness or harshness. Then, using an endoscope-a tube with a light at the end-the otolaryngologist looks directly into the throat at the vocal cords. A speech-language pathologist may also be consulted to perform videolaryngostroboscopy to make a video recording of the vocal cords to assess their anatomy and movement.
How is vocal cord paralysis treated?
There are several methods for treating vocal cord paralysis, among them surgery and voice therapy. In some cases, the voice returns without treatment during the first year after damage. For that reason, doctors often delay corrective surgery for at least a year to be sure the voice does not recover spontaneously. During this time, the suggested treatment is often voice therapy, which involves teaching the patient to compensate for the loss of movement of 1 vocal cord.
Treatment depends upon the severity of the injury. In some cases the vocal cord function may be expected to return rather quickly (within 3 months). In these cases, no treatment may be needed as the nerve recovers on its own. Voice therapy is useful in most cases.
If it is not known if the nerve is permanently damaged, surgery is an option to change the position of the paralyzed vocal cord to improve the voice. This can be accomplished by:
Injection Thyroplasty:
Injection of collagen, Gelfoam or Radiesse that adds temporary bulk to the paralyzed cord to allow the non-paralyzed cord to make closer contact with the paralized cord. The goals of this procedure are to increase volume and decrease effort (vocal strain) while giving the paralyzed cord time for its nerve to regenerate. This is a temporary strategy (lasting approximately 8 months to one year) as the body absorbes this material over this time period.
Medialization Thyroplasty:
If it is understood that the paralysis is permanent, a medialization thyroplasty is commonly performed. This involves a surgical procedure that permanently moves the paralyzed vocal cord closer to the center of the voice box to improve volume, vocal quality and reduced effort.
These surgical procedures generally improve swallowing also by reducing the occerence of choking on thin liquids.
After these procedures, patients often find a short course in voice therapy helpful in maximizing their potiential.
Treating people who have two paralyzed vocal cords may involve performing a surgical procedure called a tracheotomy to help breathing. In a tracheotomy, an incision is made in the front of the patient's neck and a breathing tube (tracheotomy tube) is inserted through a hole, called a stoma, into the trachea. Rather than breathing through the nose and mouth, the patient now breathes through the tube. Following surgery, the patient may need therapy with a speech-language pathologist to learn how to care for the breathing tube properly and how to reuse the voice.
Where can I get help?
If you notice any unexplained voice changes or discomfort, you should consult an otolaryngologist or a speech-language pathologist for evaluation and possible treatment.
Where can I get more information?
NIDCD maintains a directory of organizations that can answer questions and prvode printed or electronic information on vocal cord paralysis. Please see the list of organizations at www.nidcd.nih.gov/directory.
Use the following subject area to help you search organizations that are relevant to vocal cord paralysis:
Voice
For more information, additional addresses and phone numbers, or a printed list of organizations, contact:
NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free Voice: (800) 241-1044
Toll-free TTY: (800) 241-1055