Vocal Cord Paralysis

Vocal Cord

Paralysis

Vocal cord nerve damage results in weakness (called paresis) and immobility (called paralysis) of the vocal fold. The vocal cords no longer come together when trying to speak or swallow leaving a gap with a functional deficit.

What is the cause?

Virus infection (often after an upper respiratory infection)
Nerve injury from previous neck surgery (e.g., thyroid, parathyroid, heart, carotid, or anterior cervical spine surgery)
Nerve damage from tumors (e.g., lung cancer)
Stroke
Idiopathic (non-identifiable cause)

Symptoms

Weak and breathy voice
High-pitched voice
Running out of air when talking
Getting out of breath on exertion

Treatment

Recommended treatment options rely on many factors including the likelihood that the vocal cord paresis/paralysis will recover. Treatment aims to push the paralyzed vocal cord in a more midline position that is more suitable for talking. This can either be done by performing an injection into the vocal cord or by performing open-neck surgery.

Vocal cord injection: this procedure is usually done in the office with very minimal discomfort for the patient. It entails the injection of a dissolvable material (e.g., hyaluronic acid or hydroxyapatite) into the paralyzed vocal fold. Depending on the chosen injectable material the desired effect lasts anywhere from 2-8 months.

Medialization thyroplasty: this procedure is done in the operating room. An implant is inserted into the voice box to push the vocal cord into a favorable position. Unlike the injection, this procedure is meant to have a permanent effect and is sometimes combined with repositioning of the vocal fold joint (called arytenoid adduction).

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Both vocal cords are seen in a "breathing position." The paralyzed vocal cord (Arrow pointing to it) is unable to move. Patients with one paralyzed vocal cord typically do not have any breathing difficulties.

The vocal cords do not come together, because the left vocal cord cannot move into the middle position to vibrate with the right vocal cord. Patients typically have a high-pitched and “wispy” sounding voice. Treatment aims to move the paralyzed vocal cord into the middle and close the gap.

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