Vocal Cord Paralysis

Overview and Facts about Vocal Cord Paralysis

Vocal cords are a pair of muscles that form a V-shape in the larynx (voice box) and sit on top of the windpipe (trachea).

The vocal cords have three functions:

• They close and vibrate together to produce the sound for our voice
• They close to protect our airway and lungs from the foods and liquids we ingest
• They open to allow airflow into our lungs for breathing

When one of the functions is impaired, it can affect the other two functions, which can cause vocal cord paralysis.

Vocal cord paralysis is a condition in which the nerve impulses to your voice box that create sound are disrupted, which causes paralysis in the vocal cord muscles. Vocal cord paralysis can affect your ability to speak or even breathe.

Symptoms and Signs of Vocal Cord Paralysis

Common signs and symptoms of vocal cord paralysis could include the following:

Tests and Diagnosis of Vocal Cord Paralysis

Anything that affects the vagus nerve or recurrent laryngeal nerve (RLN) from the brain to the chest can cause a paralysis of a vocal cord. Causes include:

• Inflammation from viral or bacterial infections
• Injury to the vocal cords
• Neck or chest injury/trauma
• Neurological conditions like multiple sclerosis or Parkinson’s disease
• Tumors that affect the nerve

Causes and Risk Factors of Vocal Cord Paralysis

An otolaryngology specialist, or ENT doctor, can test for and diagnose vocal cord paralysis. He or she will ask you about the history of your voice problems before performing tests. Diagnostic tests for this condition may include:

• CT scans: If the cause of the vocal cord paralysis is unknown, CT scans of the neck and chest are commonly ordered. They will search for the reason of the paralysis by examining all of the areas along the course for the vagus nerve that can affect the vocal cords.
• Videostroboscopy: A flexible scope with a camera is inserted through the nose and fed into the larynx to visualize the vocal cords. A strobe light makes the vocal cords appear in slow motion and the examination is recorded. This study diagnoses vocal cord paralysis, evaluates for possible causes of the paralysis and assesses for possible treatments.
• Video swallow study: This test is performed in the radiology department with a speech and swallowing therapist. It involves swallowing a barium solution under X-ray visualization to determine if aspiration is occurring. Aspiration poses a significant risk for pneumonia.
• FEES (Flexible Endoscopic Evaluation of Swallowing): This is an alternative and complementary test to evaluate swallowing function and aspiration potential. A flexible scope with a camera is inserted through the nose and positioned in the throat. With the scope in place, your swallowing function is assessed by visualizing where the swallowed materials flow.

Treatment and Care for Vocal Cord Paralysis

The best treatment option for vocal cord paralysis will depend on the cause, how bad the symptoms are and when the symptoms started.

Treatment options can include voice therapy to strengthen the vocal cords, bulk injections to bring the vocal cord closer to the middle of the voice box to alleviate symptoms (these can be temporary or permanent), or possibly surgery. Surgeries that may be appropriate can include:

• Reinnervation: surgery to replace the damaged nerve with a healthy nerve from elsewhere in the neck. Although no movement is restored, the procedure increases the muscle tone in the paralyzed vocal cord and pushes it over.
• Vocal cord implants: permanent material (either silastic or gortex) is used to push the vocal cord over permanently.
• Vocal cord repositioning: when the surgeon moves some of the tissue from the outside of your voice box to the inside, which pushes the paralyzed cord in the right direction.