Vocal Cord Paralysis

Vocal cord paralysis is a common disorder that occurs when nerve impulses to the larynx (commonly known as the voice box) are interrupted. This malfunction, which may occur in one or both vocal cords, not only affects the patient's ability to speak, but may interfere with normal breathing or swallowing. When a vocal cord does not open or close properly, food or liquids can slip into the trachea (windpipe). Vocal cord paralysis occurs more frequently in women, in those with certain neuromuscular disorders and in those who have undergone surgery of the throat or neck.

Causes of Vocal Cord Paralysis

The cause of vocal cord paralysis is often unknown, but some cases may result from:

  • Vocal cord injury during throat or neck surgery
  • Neck or chest trauma
  • Stroke
  • Benign or malignant tumors
  • Certain cancers
  • Inflammation due to arthritis, surgery or viral infection

Vocal cord paralysis may also be caused by neuromuscular diseases such as Parkinson's disease.

Symptoms of Vocal Cord Paralysis

Since symptoms of vocal cord paralysis may mimic symptoms of other, less serious voice problems, changes in voice quality that are severe or persistent should always be medically evaluated. These symptoms may include:

  • Hoarseness
  • Noisy breathing
  • Loss of vocal pitch
  • Difficulty speaking loudly
  • Breathy or weak voice
  • Frequent breaths while speaking
  • Loss of gag reflex
  • Frequent throat clearing

Choking or coughing while swallowing food, drink or saliva can also be a symptom of vocal cord paralysis.

Diagnosis of Vocal Cord Paralysis

Vocal cord paralysis is diagnosed through physical examination and a series of diagnostic tests, including:

  • Endoscopy
  • Laryngeal electromyography
  • Tests for lung function
  • X-rays
  • MRI or CT scan

Blood tests may also be performed to test for or nerve disease.

Treatment of Vocal Cord Paralysis

Treatment for vocal cord paralysis depends on the cause, severity and duration of the condition. Some patients recover from this condition with no treatment, while others may require voice therapy, filler injections or surgery. Voice therapy works to strengthen the vocal cords, improve breath control during speech and keep the airway protected. If voice therapy is an insufficient remedy for vocal cord paralysis, one of the following procedures may be performed:

  • Bulk injection of collagen or other filler
  • Vocal cord repositioning (phonosurgery), using implants
  • Nerve reinnervation
  • Thyroplasty
  • Tracheotomy, in extreme cases

Voice therapy is usually prescribed after any of these procedures in order to strengthen the vocal cords and help the patient adapt to vocal cord repairs.

Complications of Vocal Cord Paralysis

Because of the proximity of the vocal cords to the pathways for respiration and digestion, vocal cord paralysis can result in life-threatening risks. In severe cases of this disorder, patients may suffer dangerous breathing problems. There is also a risk that food or drink will enter the trachea. This is called aspiration and may lead to a particularly virulent form of pneumonia.

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