Houston ENT and Allergy Blog

Vocal Cord Paresis (Paralysis): Symptoms, Causes, and Treatment Options

By:
Michael P Underbrink, MD
October 26, 2019

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Vocal cord paralysis can impact how you speak and breathe, resulting in vocal cord muscle paralysis.This is due to your vocal cords (or your vocal folds) doing much more than simply produce sound. Your vocal cords also keep your airway protected by preventing your saliva, your food and your drinks from entering your trachea (windpipe) and causing you to choke.

What Is Vocal Cord Paresis?

The Vocal Cord Paresis definition is:  Paralysis of the vocal cords is a condition of your voice that can occur when one or both of your vocal cords don't properly open or close. More common is single vocal cord paralysis. But, paralysis of both your vocal cords can occur and can be life-threatening, though rare.

Your vocal cords (folds) are a couple of elastic muscle tissue bands found in your voice box (larynx) right above your windpipe. When you're breathing, they stay apart and when you're swallowing, they're closed tightly. However, when you use your voice, the air from your lungs can cause your vocal cords to vibrate between the open and closed positions.

When you are suffering with paralysis of the vocal cord, the paralyzed cords can stay open and leave your lungs and air passages unprotected. This can cause problems swallowing or you could have food or drinks mistakenly enter your lungs and trachea which causes serious health problems.

 

Symptoms of Vocal Cord Paralysis (Paresis)

Symptoms and signs of vocal cord paralysis could include:

  • Noisy breathing

  • A breathy voice quality

  • Coughing or choking while you swallow drink, food or saliva

  • Hoarseness

  • Inability to speak loudly

  • Loss of vocal pitch

  • Ineffective coughing

  • Loss of your gag reflex

  • Frequent throat clearing

  • The need to take breaths often when you speak

 

Vocal Cord Paresis (Paralysis) Causes

The cause of this condition could determine if your disorder will get better over time or if it will be permanent. When you have a reversible cause, the doctor will likely not recommend surgery since the chances of spontaneous resolution of the paralysis is possible. 

Although there are diagnostic technology advances, doctors can't detect the cause if a lot of vocal cord paralysis cases. When this occurs, it's called idiopathic (because of unknown origins).In an idiopathic case, paralysis may be caused by a viral infection that affects the RLN or SLN voice box nerves or the vagus nerve, but this can't be proven in a lot of cases.

Some known causes of injury are: 

  • Inadvertent surgery injury: Neck surgery (i.e. surgery of the carotid artery or thyroid gland) or chest surgery (i.e. surgery of the esophagus, lung, large blood vessels or heart) might inadvertently lead to RLN paralysis or paresis. The SLN can also become injured during neck and head surgery.

  • Blunt chest or neck trauma: Any form of hard, penetrating impact on the chest or neck region could injure the RLN or an impact to your neck could injure your SLN.

  • Endotracheal intubation complication: RLN injury might occur when the doctor uses breathing tubes to assist in artificial ventilation or for general anesthesia. But, this form of injury is rare, seeing as how there are many surgeries performed under general anesthesia.

  • Tumors of your neck, chest and skull base: Tumors (both non-cancerous and cancerous) could grow around your nerves, squeezing them and lead to varying degrees of paralysis.

  • Viral infections: Viral infection inflammation could involve and injure your RLN and SLN voice box nerve branches or your vagus nerve. Systemic conditions that affect nerves in your body could also impact your voice box nerves.

 

Vocal Cord Paresis (Paralysis) Treatment Options

Treatment for paralysis of the vocal cords depend on things like:

  • How serious your symptoms are

  • The cause

  • The time from symptom onset

Treatment could include bulk injections, voice therapy, an operation or the combination of any treatments.

Sometimes, you could get better without needing surgery. The doctor might wait to do surgery for a minimum of a year from the start of your paralysis of the vocal cords for this reason.

But, surgery with bulk injections that contain collagen-like components is often performed within the first several months of voice loss.

Your doctor might recommend voice therapy during your waiting period for surgery to help keep you from improperly using your voice while the nerves are healing.

Voice Therapy

Voice therapy involves activities and exercises that help to:

  • Enhance breath control during speech

  • Vocal cord strengthen 

  • Protect your airway when you swallow

  • Prevent irregular tension in your other muscles surrounding the paralyzed vocal cords

In some cases, voice therapy might be your only required treatment if the vocal cords became paralyzed in an area that won't require additional repositioning or bulk.

Surgery

If your symptoms don't completely recover by themselves, surgery could help enhance your ability to swallow and speak.

Some options of surgery are:

  • Bulk injection: Vocal cord nerve paralysis will likely leave your vocal cord muscle weak and thin. A doctor specializing in larynx disorders might inject collagen, body fat or another approved filler into your vocal cord to add bulk. The extra bulk brings your impacted vocal cord closer to your vocal box in the middle so your opposite moving and functionable vocal cord can get close with the cord that's paralyzed when you're swallowing, speaking or coughing.

  • Vocal cord repositioning: A surgeon, during this procedure, will move some of your own tissue inward from the outside of your vocal box which will push the paralyzed cord toward your voice box in the middle, allowing the unimpaired vocal cord to vibrate against the paralyzed one better.

  • Structural implants: Rather than using a bulk injection, in this surgery, also referred to as medialization laryngoplasty, thyroplasty or laryngeal framework surgery, requires the use of a larynx implant for repositioning your vocal cord. 

  • Reinnervation (replacing your damaged nerve): During this procedure, the surgeon moves a healthy nerve from a different neck area to replace the vocal cord with damage. It could take some time for your voice to improve. This procedure could also be combined with bulk injection.

  • Tracheotomy: If you have two paralyzed vocal cords and they're closely positioned together, you'll experience decreased airflow. In this case, it can result in difficulty breathing and you'd require a tracheotomy. This is where the surgeon makes an incision in your neck in the front and an opening directly into your trachea. They then insert a breathing tube which allows air to bypass your paralyzed vocal cords.

Vocal cord(s) paralysis can be debilitating and frustrating, particularly since your voice affects how you communicate. Chances are you'll first see your primary doctor, but if you have two paralyzed vocal cords, you may need to go to the emergency department first.

After your initial evaluation, the doctor will likely refer you to an ENT doctor, or a doctor specializing in ear, nose and throat conditions. They might also refer you to a speech-language pathologist who will provide you with voice assessment and therapy.

If you are having symptoms of vocal cord paresis (paralysis), please schedule an appointment with Houston ENT & Allergy Services /  Voice and Swallowing Center of Houston Ear, Nose, Throat & Allergy Clinic. Call 281-623-1212 to schedule an appointment or complete our online form.

By: Michael P Underbrink, MD

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