Vocal cord paralysis occurs when the nerve impulses to your voice box (larynx) are disrupted. This results in paralysis of the vocal cord muscles.
Vocal cord paralysis can affect your ability to speak and even breathe. That's because your vocal cords, sometimes called vocal folds, do more than just produce sound. They also protect your airway by preventing food, drink and even your saliva from entering your windpipe (trachea) and causing you to choke.
Possible causes include nerve damage during surgery, viral infections and certain cancers. Treatment for vocal cord paralysis usually involves surgery, and sometimes voice therapy.
Your vocal cords are two flexible bands of muscle tissue that sit at the entrance to the windpipe (trachea). When you speak, the bands come together and vibrate to make sound. The rest of the time, the vocal cords are relaxed in an open position, so you can breathe.
In most cases of vocal cord paralysis, only one vocal cord is paralyzed. Paralysis of both of your vocal cords is a rare but serious condition. This can cause vocal difficulties and significant problems with breathing and swallowing.
Signs and symptoms of vocal cord paralysis may include:
If you have unexplained, persistent hoarseness for more than two weeks, or if you notice any unexplained voice changes or discomfort, contact your doctor.
In vocal cord paralysis, the nerve impulses to your voice box (larynx) are disrupted, resulting in paralysis of the muscle. Doctors often don't know the cause of vocal cord paralysis. Known causes may include:
Factors that may increase your risk of developing 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.
Because vocal cord paralysis keeps the opening to the airway from completely opening or closing, other complications may include choking on or actually inhaling (aspirating) food or liquid. Aspiration that leads to severe pneumonia is rare but serious and requires immediate medical care
Your doctor will ask about your symptoms and lifestyle, listen to your voice, and ask you how long you've had voice problems. To further evaluate your voice problems, the following tests may be performed:
Laryngoscopy. Your doctor will look at your vocal cords using a mirror or a thin, flexible tube (known as a laryngoscope or endoscope) or both. You may also have a test called videostrobolaryngoscopy that's done using 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 doctor to view your vocal cords directly or on a video monitor to determine the movement and position of the vocal cords and whether one or both vocal cords are affected.
Laryngeal electromyography. This test measures the electric currents in your voice box muscles. To obtain these measurements, your doctor typically inserts small needles into your vocal cord muscles through the skin of the neck.
This test doesn't usually provide information that might change the course of treatment, but it may give your doctor information about how well you may recover. This test is most useful for predicting how you'll recover when it's done between six weeks and six months after your symptoms began.
Treatment of vocal cord paralysis depends on the cause, the severity of symptoms and the time from the onset of symptoms. 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 doctor may delay permanent surgery for at least a year from the beginning of your vocal cord paralysis.
However, surgical treatment with bulk injections containing collagen-like substances is often done within the first 3 months of voice loss.
During the waiting period for surgery, your doctor may suggest 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, improve breath control during speech, prevent abnormal tension in other muscles around the paralyzed vocal cord or cords and protect your airway during swallowing. Occasionally, voice therapy may be the only treatment you need if your vocal cords were paralyzed in a location that doesn't require additional bulk or repositioning.
If your vocal cord paralysis symptoms don't fully recover on their own, surgical treatments may be offered 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. In this situation, you'll have a lot of trouble breathing and require a surgical procedure called a tracheotomy.
In a tracheotomy, an incision is made in the front of your neck and an opening created directly into the windpipe (trachea). A breathing tube is inserted, allowing air to bypass the immobilized vocal cords.
Linking the vocal cords to an alternative source of electrical stimulation — perhaps a nerve from another part of the body or a device similar to a cardiac pacemaker — may restore opening and closing of the vocal cords. Researchers continue to study this and other options.
Vocal cord paralysis can be frustrating and sometimes debilitating, especially because your voice affects your ability to communicate. A speech therapist can help you develop the skills you need to communicate.
Even if you're not able to regain the voice you once had, voice therapy can help you learn effective ways to compensate. In addition, a speech-language pathologist can teach you efficient ways to use your voice without causing further damage to the vocal mechanism.
You're likely to first see your primary care doctor unless both vocal cords are paralyzed. In that case, 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 disorders. You may also 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 from your doctor.
Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. For vocal cord paralysis, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask any additional questions that occur to you during your appointment.
Your doctor is likely to ask you a number of questions, such as: