Vocal Cord Paralysis: Causes, Treatment and diagnosis

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MNT Knowledge CenterVocal cord paralysis, also known as vocal cord paresis, is the inability of one or both vocal cords (vocal folds) to move.

It may greatly effect on the daily existence from the sufferer, including employment, selection of job, social interactions and free time activities.

In the following paragraphs we’ll consider the causes, treatment and diagnosis of vocal cord paresis.

Contents of this article:

  1. Symptoms, risk factors and causes of vocal cord paralysis
  2. Diagnosis and treatment of vocal cord paralysis

Fast facts on vocal cord paralysis

Here are some key points about vocal cord paralysis. More detail and supporting information is in the main article.

  • Vocal cord paralysis is caused by nerve damage
  • The disease can cause a number of problems including the inability to speak
  • Choking is a hazard for people with vocal cord paralysis
  • Most often, only one of the two vocal cords are affected by vocal cord paralysis
  • Coughs and sneezes may become ineffective, allowing a build up of fluids and possible infections
  • More females than males develop vocal cord paralysis
  • Some neurological conditions, such as Parkinson’s disease, raise the chances of developing vocal cord paralysis
  • Voice therapy can help in certain circumstances
  • Sometimes, no underlying cause for the condition can be found.

What is vocal cord paralysis?

[Vocal cord and trachea]
Vocal cord paralysis normally only affects one of the vocal cords.

The problem is because harm to nerves visiting the vocal cord – the nerve impulses within the larynx (voice box) are interrupted, leading to paralysis from the vocal cord muscles. It is also brought on by brain damage.

Patients with vocal paralysis typically experience hoarseness, vocal fatigue, mild to severe decrease in speech volume, a discomfort within the throat when talking, and swallowing things lower the wrong manner and choking.

The vocal cords, in addition to permitting us to create utterances (speak, etc.) also safeguard the airway, stopping food, drink and saliva from entering the trachea (windpipe). In extraordinary instances the resultant choking can result in dying.

People with vocal cord paralysis might find the potency of coughing, swallowing or sneezing in getting rid of laryngeal area waste is undermined reduced vocal cord mobility. This may lead to accumulations in the region, permitting for microbial and viral colonization, and subsequent infections and throat discomfort.

Symptoms of vocal cord paralysis

The vocal cords contain two bands of muscle, situated in the trachea (entrance towards the windpipe). Whenever we make an utterance (produce seem in the mouth) the 2 bands of muscle tissues touch one another and vibrate. If we are not uttering sounds the vocal cords have been in a wide open, relaxed position, permitting air to circulate freely into our windpipe – permitting us to breathe.

Many instances of vocal cord paralysis involve only one cord being disabled. However, sometimes both of them are affected, and also the patient will probably experience swallowing in addition to the like.

Potential signs and symptoms of vocal cord paralysis include:

  • Changes to the voice – it may become more “breathy,” like a loud whisper
  • Hoarseness, huskiness
  • Noisy breathing
  • Changes to vocal pitch
  • Coughs that do not clear the throat properly
  • When swallowing solids or liquids, the patient might choke (including saliva sometimes)
  • While speaking, the sufferer may have to catch their breath more often than usual
  • Voice volume may be affected – the patient may not be able to raise their voice
  • Pharyngeal reflex (gag reflex) may be lost – the pharyngeal reflex is a reflex contraction of the back of the throat, evoked by touching the soft palate. It prevents something from entering the throat except as part of normal swallowing and helps prevent choking.

Causes of vocal cord paralysis

[Brain scans]
Some neurological conditions – multiple sclerosis, Parkinson’s disease – increase the risk of vocal cord paralysis.

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

The following factors may raise the chances of developing vocal cord paralysis:

  • Gender: females have a slightly higher risk than males
  • Some types of surgery: especially chest or throat surgery. Breathing tubes used in surgery may damage vocal cord nerved. Cardiac surgery represents a risk to normal voice function as the nerves serving the larynx are routed near the heart – damage to this nerve during open heart surgery is not uncommon. The recurrent laryngeal nerve also runs close to the thyroid gland making, hoarseness of voice due to partial paralysis an important side effect of thyroid surgery
  • Certain neurological conditions: people with multiple sclerosis (MS), Parkinson’s disease, or myasthenia gravis have a higher risk of developing vocal cord paralysis, compared to other individuals. The risk of vocal cord weakness is greater than paralysis
  • Injury to the chest or neck: a trauma may damage the nerves that serve the vocal cords or the larynx
  • Stroke: the part of the brain that sends messages to the larynx (voice box) may be damaged from a stroke
  • Tumors: these may develop around or in the cartilages, nerves or muscles of the voice box. The tumors may be benign or malignant (cancerous)
  • Inflammation or scarring of the vocal cord joints: as well as the space between the two vocal cord cartilages may prevent the larynx from working properly. Although the cord nerves are usually working correctly, the inflammation can give vocal cord paralysis-like signs and symptoms. Some infections may also cause inflammation.

Vocal cord paralysis may also be idiopathic – there may be no identifiable cause.

On the next page, we look at the diagnosis and treatment of vocal cord paralysis.

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Diagnosing vocal cord paralysis

Initially, the patient will probable see a GP (general practitioner, primary care physician) who will ask about symptoms and check out for some signs, such as listening to their voice and asking how long there have been problems.

The following diagnostic tests may also be ordered:

  • Endoscopy – a long, thin, flexible tube (endoscope) is used to look at the vocal cords. A special device with a small camera at the end (videostrobolaryngoscopy) may be used. The doctor can get a good look at the vocal cords on a monitor.
  • Laryngeal electromyography (LEMG) – electric currents in the larynx muscles are measured. Small needles are inserted into the vocal cord muscles through the skin of the neck. The test measures the strength of the neuromuscular signal from the brain to the muscles controlling the vocal folds (cords). During an LEMG the doctor will ask the patient to perform a number of tasks that would normally activate the muscles.
  • Other tests – the doctor may order blood tests and imaging scans, such as X-rays, CT scans, MRI scans to help determine the cause of the paralysis.

Treatment for vocal cord paralysis

[Doctor examining patient's mouth]
Voice therapy can help in some cases of vocal cord paralysis.

Vocal cord paralysis treatment depends on several factors, including what caused it, how severe symptoms are, and how long they have been present. The patient may be advised to have voice therapy, surgery or both.

Voice therapy – the equivalent of physical therapy for large muscle paralysis. The therapist asks the patient to do special exercise and some other activities to strengthen their vocal cords, improve their breath and control while speaking, prevent unusual tensions in other muscles near the affected vocal cord(s), and protect the airway from liquids and solids.

Surgery – if the patient does not recover completely with voice therapy, the doctor may recommend surgical intervention:

  • Bulk injection – the vocal cord muscle will most likely be weak due to paralysis of the nerve. The otolaryngologist (ear, nose and throat specialist doctor) may inject fat, collagen or some filler into the vocal cord. The extra bulk brings the vocal cord nearer to the middle of the larynx (voice box), making it easier for the opposite cord muscle to move effectively when the patient coughs, swallows or speaks.
  • Phonosurgery (vocal cord repositioning) – this operation repositions and/or reshapes the vocal fold (cord) to improve voice functions.
  • Tracheotomy – if both vocal folds (cords) are affected and very close to each other, breathing will be more difficult because of decreased air flow. The doctor makes an incision (cut) in front of the neck and an opening is created into the trachea (windpipe). A breathing tube is inserted so that the patient can breathe with air bypassing the paralyzed vocal cords. Put simply, the patient breathes through a hole in the neck because the opening in the larynx is too small for proper breathing.

Complications of vocal cord paralysis

Breathing – if symptoms are severe enough the patient can have serious, life-threatening breathing problems.

Aspiration – because there is paralysis in the area where food or liquid may go down the wrong way (aspiration), there is a risk of choking. Aspiration can lead to severe pneumonia.

Recent developments on vocal cords from MNT news

High-power voices ‘more monotone and louder’

When former United kingdom Pm Margaret Thatcher was at office, she went through extensive voice coaching to demonstrate a far more authoritative and effective tone. Now, scientists from North Park Condition College in California have carried out a number of experiments to look at how being ready of power can alter the way in which a person talks.

Researchers grow working vocal cord tissue in lab

Researchers have effectively grown vocal cord tissue within the lab and proven it may produce realistic seem when grafted into voice boxes which have been mounted on a man-made windpipe that blows air through them.

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