Vocal Cord Paralysis
What is vocal cord paralysis?
Vocal cord paralysis (or vocal fold paralysis) is a condition that affects how the vocal cords work. People with this condition can’t control the muscles that open and close the vocal cords. Their inability to control these muscles results from nerve damage. Several diseases and conditions can cause this type of nerve damage.
Most often, only one vocal cord doesn’t work like it should. Sometimes, this condition affects both vocal cords. Vocal cord paralysis causes problems with speaking and swallowing. If both vocal cords don’t work properly, life-threatening breathing problems can occur.
Providers who are specialists in laryngology treat vocal cord paralysis with voice therapy and surgery. People with double vocal cord paralysis can have a dangerously narrow airway and will often need a tracheostomy (tracheotomy or “trach”) to open the airway and help with breathing.
What are the vocal cords?
Vocal cords (vocal folds) are small, flexible muscles. You have two vocal cords inside your larynx (voice box). Your larynx sits at the top of your trachea (windpipe) at the back of your throat. Your vocal cords open when you breathe and close tightly when you swallow. When you speak or sing, your vocal cords close and your lungs send air through them, causing them to vibrate and make sound.
Vocal cords play a critical role in helping us talk, breathe and swallow. Vocal cord paralysis of one cord causes the vocal cords to remain open. Food, saliva and other liquids can get into the windpipe and the lungs, which can be fatal. When both cords are paralyzed, they usually end up very close together, causing a dangerously narrow airway which can lead to difficulty breathing and may also be fatal.
How common is vocal cord paralysis?
Single vocal cord paralysis is much more common than double vocal cord paralysis. People of all ages and genders can get the condition. But women are more likely to have vocal cord paralysis than men. It’s rare for both vocal cords to become paralyzed.
Symptoms and Causes
What are the symptoms of vocal cord paralysis?
Vocal cord paralysis symptoms range from mild to severe. Sometimes symptoms go away without treatment, or they may be long-lasting. They can also get worse over time. Symptoms include:
- Changes in the voice: Your voice may sound hoarse, scratchy, weak or “breathy.” When you speak, you may hear a gurgling sound or air escaping. The tone of the voice might sound different, too. It may be higher or lower than before. You may run out of air easily as you try to speak.
- Difficulty swallowing: You may choke when you try to swallow, and food or liquid may get stuck in your throat. Coughing might not bring up the food or liquid, and you might feel like you always have mucus in your throat. Providers call these swallowing problems dysphagia. Sometimes, food or saliva may enter your windpipe, which can cause choking or pneumonia.
- Trouble breathing: You may hear a wheezing or raspy sound when you breathe. It may be hard for you to take a full breath. Shortness of breath (dyspnea) can happen following activity, exercise or after talking for a while. Breathing problems don’t usually happen when only one vocal cord is paralyzed.
What causes vocal cord paralysis?
About half the time providers don’t know what causes vocal cord paralysis. Some providers think inflammation from a cold can damage the nerves and stop the muscles from working like they should.
Vocal cord paralysis can result from several conditions, diseases, injuries and infections, including:
- Autoimmune diseases such as myasthenia gravis (MG).
- Cancer, such as lung cancer and thyroid cancer.
- Connective tissue disorders like Marfan syndrome.
- Infections like Lyme disease.
- Injuries and other trauma to the neck, head and chest.
- Neurological conditions, including multiple sclerosis (MS), Parkinson’s disease and damage from a stroke.
- Poisonous substances such as lead and mercury.
- Surgery, including heart surgery, thyroidectomy (thyroid gland removal) and mechanical ventilation (breathing tube).
- Tumors, including cancerous (malignant) tumors and noncancerous (benign) tumors. They can push on the nerves and cause damage.
Diagnosis and Tests
How do healthcare providers diagnose vocal cord paralysis?
Your provider will ask about your symptoms and health history to determine what’s causing the paralysis. They may order a blood test to look for autoimmune disorders. To confirm a diagnosis, your provider may order:
- Imaging studies: An MRI or CT scan shows detailed images of your brain, throat, vocal cords, voice box, thyroid gland and chest. Your provider may also order an X-ray of the esophagus.
- Laryngoscopy: Your provider will insert a long, thin tube into your nose to examine your throat. The flexible tube has a camera on the end. Images from the camera appear on a monitor. Your provider will then look at images of your voice box and vocal cords.
- Laryngeal electromyography (LEMG): This test measures how your nerves control the muscles in your voice box. It evaluates and records the electrical impulses of the muscles.
Management and Treatment
How do providers treat vocal cord paralysis?
If paralysis is mild, your provider may recommend voice therapy to improve how your vocal cords work. During therapy, you do special exercises to strengthen your vocal cords, improve how you breathe while speaking and teach you to control muscles that help you speak. More severe vocal cord paralysis — especially if causes trouble swallowing — may require surgery.
To treat paralysis in one vocal cord, your provider moves the vocal cord to the correct position during surgery. To keep your vocal cord in place and close the space between your vocal cords, they may:
- Inject a filler (vocal cord injection): Your provider may inject a filler material through a needle. There are several types of filler material. The filler closes the gap between your vocal cords.
- Insert a voicebox implant (laryngeal framework surgery): Your provider places an implant into your voice box. Most commonly, the implant is silicone. It holds the paralyzed vocal cord in place and helps both of the vocal cords close. This procedure requires a small incision (cut) in the neck. This is most commonly performed in adults or older children.
- Nerve surgery (reinnervation): Your provider takes a nerve that connects to other muscles in your neck and re-attaches it to the nerve that moves your vocal cords. This does not cause any problems with the other muscles in your neck. It is most helpful in children.
- If both vocal cords are paralyzed, you may need a tracheostomy. During this procedure, your provider makes an incision and inserts a tube into your throat. The tube opens the airway and helps you breathe. To help you breathe long-term, your provider may recommend a tube-free tracheostomy. In some cases, your provider may remove a portion of one or both vocal cords with a laser to widen the airway.
Can I prevent vocal cord paralysis?
You may not be able to prevent vocal cord paralysis. If you have a condition that puts you at a higher risk, talk to your provider. They may recommend regular checkups to test your vocal cords. This helps your provider diagnose problems as soon as they appear. You may need voice therapy to improve how your vocal cords work.
Outlook / Prognosis
What is the outlook for people with vocal cord paralysis?
Mild cases of vocal cord paralysis can get better with voice therapy and rest. If your provider inserted an implant to keep your vocal cord in place, you may need additional procedures later. Your provider may need to readjust the implant if it moves out of place.
With treatment, many people regain the ability to talk and swallow after vocal cord paralysis. Your prognosis depends on several factors, including whether one or both vocal cords had damage and how quickly you got treatment.
When should I see my healthcare provider about vocal cord paralysis?
Talk to your provider if you have signs of vocal cord paralysis or vocal cord dysfunction. Paralysis that affects both vocal cords is life-threatening. Get help right away if you have trouble breathing or swallowing.
When vocal cords don’t work like they should, fluid and food can enter the trachea (windpipe) and get into the lungs. These fluids can stay in the lungs and become infected, leading to aspiration pneumonia. Untreated, long-term problems with swallowing, speaking and breathing can result from vocal cord paralysis.
A note from Cleveland Clinic
If you have signs of vocal cord paralysis, including trouble breathing, voice changes or difficulty swallowing, see your provider. Though uncommon, paralysis in both vocal cords can be fatal. Talk to your provider if you have a condition or illness that increases your risk of vocal cord paralysis. These can include MS or Parkinson’s, or recent chest or neck surgery. Voice therapy may prevent the condition from worsening and improve your vocal cord function.
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