Vocal cord paralysis is a condition that causes the loss of control of the muscles that control the voice. It happens when the nerve impulses to the voice box, also called the larynx, are disrupted. This results in paralysis of the vocal cord muscles.
Vocal cord paralysis can make it hard to speak and even breathe. The vocal cords, also called vocal folds, do more than just produce sound. They also protect the airway. They prevent food, drink and even saliva from entering the windpipe and causing a person to choke.
Possible causes of vocal cord paralysis include nerve damage during surgery, viral infections and certain cancers. Treatment for vocal cord paralysis usually involves surgery, and sometimes voice therapy.
Vocal cord paralysis usually involves the loss of control of only one vocal cord. Paralysis of both vocal cords is a rare but serious condition. This can make it hard to speak and can cause trouble with breathing and swallowing.
The vocal cords are two flexible bands of muscle tissue that sit at the entrance to the windpipe, also known as the trachea. When speaking, the bands come together and vibrate to make sound. The rest of the time, the vocal cords are relaxed in an open position so that you can breathe.
Symptoms of vocal cord paralysis may include:
Contact your healthcare professional if you have a hoarse voice that can't be explained and that lasts for more than 2 to 4 weeks. Also see your healthcare professional if you notice any voice changes or discomfort.
Vocal cord paralysis happens when nerve impulses to the voice box, known as the larynx, are disrupted. This causes the muscle to become paralyzed. Often the exact cause of vocal cord paralysis isn't known. But some known causes may include:
Risk factors for vocal cord paralysis include:
Breathing problems associated with vocal cord paralysis may be so mild that you just have a hoarse-sounding voice. Or they can be so serious that they're life-threatening.
Vocal cord paralysis keeps the opening to the airway from completely opening or closing. This can cause someone to choke on or inhale food or liquid, known as aspiration. Aspiration that leads to severe pneumonia is rare but serious and requires immediate medical care.
To diagnose vocal cord paralysis, your healthcare professional asks about your symptoms and lifestyle. Your care professional also listens to your voice and asks how long you've had voice changes. You also may need the following tests:
Laryngoscopy. Your healthcare professional looks at your vocal cords using a mirror or a thin, flexible tube known as a laryngoscope or endoscope, or both. You also may have a test called videostrobolaryngoscopy. It uses a special scope that contains a tiny camera at its tip or a larger camera connected to the scope's viewing piece.
These special high-magnification endoscopes allow your healthcare professional to view your vocal cords directly or on a video monitor. The tests reveal the movement and position of the vocal cords. This can tell your healthcare professional whether one or both vocal cords are affected.
Laryngeal electromyography. This test measures the electrical currents in your voice box muscles. To do this, small needles are inserted into the vocal cord muscles through the skin of the neck.
This test isn't used to guide treatment, but it may give an estimate about how well you may recover. This test is most useful when it's done between six weeks and six months after your symptoms began.
Treatment of vocal cord paralysis depends on the cause, how serious the symptoms are and when symptoms began. Treatment may include voice therapy, bulk injections, surgery or a combination of treatments.
In some instances, you may get better without surgical treatment. For this reason, your healthcare team may delay permanent surgery for at least a year from the beginning of your vocal cord paralysis.
However, surgical treatment with various bulk injections is often done within the first three months of voice loss.
During the waiting period for surgery, you may get voice therapy to help keep you from using your voice improperly while the nerves heal.
Voice therapy sessions involve exercises or other activities to strengthen your vocal cords and help improve breath control during speech. Voice therapy also can prevent tension in muscles around the paralyzed vocal cord or cords, and protect your airway during swallowing. Voice therapy may be the only treatment needed if the paralysis occurs in an area that doesn't require additional bulk or repositioning.
If your vocal cord paralysis symptoms don't fully recover on their own, you may need surgery to improve your ability to speak and to swallow.
Surgical options include:
Tracheotomy. If both of your vocal cords are paralyzed and positioned closely together, your airflow will be decreased. This causes a lot of trouble breathing and requires a surgery called a tracheotomy.
A cut is made in the front of your neck to create an opening in the windpipe, also known as the trachea. A breathing tube is inserted, allowing air to bypass the vocal cords.
Linking the vocal cords to another source of electrical stimulation may restore opening and closing of the vocal cords that can't move. Other sources of electrical stimulation might be a nerve from another part of the body or a device similar to a cardiac pacemaker. Researchers continue to study this and other options.
Vocal cord paralysis can be frustrating and affect your daily life. It can be hard to communicate with other people. A speech therapist can help you develop the skills you need to communicate.
Even if you're not able to get back the voice you once had, voice therapy can help you learn effective ways to make up for it. In addition, a speech-language pathologist can teach you how to use your voice without causing further damage to the vocal cords.
You're likely to first see your healthcare professional about vocal cord paralysis. But if both vocal cords are paralyzed, you'll probably first be seen in a hospital emergency department.
After the initial assessment, you'll likely be referred to a doctor who specializes in ear, nose and throat conditions. You also may be referred to a speech-language pathologist for voice assessment and therapy.
It's helpful to arrive well prepared for your appointment. Here's some information to help you get ready and what to expect.
Your time with your healthcare professional may be limited. Preparing a list of questions can help you make the most of your time together. For vocal cord paralysis, some basic questions to ask include:
In addition to the questions that you've prepared to ask, don't hesitate to ask any additional questions that occur to you during your appointment.
Your healthcare professional is likely to ask you a number of questions, such as:
