Paralysis
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Paralysis
Overview
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.
Symptoms
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:
- A breathy quality to the voice
- Hoarseness
- Noisy breathing
- Loss of vocal pitch
- Choking or coughing while swallowing food, drink or saliva
- The need to take frequent breaths while speaking
- Inability to speak loudly
- Loss of your gag reflex
- Ineffective coughing
- Frequent throat clearing
Causes
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:
- Injury to the vocal cord during surgery. Surgery on or near your neck or upper chest can result in damage to the nerves that serve your voice box. Surgeries that carry a risk of damage include surgeries to the thyroid or parathyroid glands, esophagus, neck, and chest.
- Neck or chest injury. Trauma to your neck or chest may injure the nerves that serve your vocal cords or the voice box itself.
- Stroke. A stroke interrupts blood flow in your brain and may damage the part of your brain that sends messages to the voice box.
- Tumors. Tumors, both cancerous and noncancerous, can grow in or around the muscles, cartilage or nerves controlling the function of your voice box and can cause vocal cord paralysis.
- Infections. Some infections, such as Lyme disease, Epstein-Barr virus and herpes, can cause inflammation and directly damage the nerves in the larynx.
- Neurological conditions. If you have certain neurological conditions, such as multiple sclerosis or Parkinson’s disease, you may experience vocal cord paralysis.
Risk factors
Factors that may increase your risk of developing vocal cord paralysis include:
- Undergoing throat or chest surgery. People who need surgery on their thyroid, throat or upper chest have an increased risk of vocal cord nerve damage. Sometimes breathing tubes used in surgery or to help you breathe if you’re having serious respiratory trouble can damage the vocal cord nerves.
- Having a neurological condition. People with certain neurological conditions — such as Parkinson’s disease or multiple sclerosis — are more likely to develop vocal cord weakness or paralysis.
Complications
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.
Diagnosis
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.
- Blood tests and scans. Because a number of diseases may cause a nerve to be injured, you may need additional tests to identify the cause of the paralysis. Tests may include blood work, X-rays, MRI or CT scans.
Treatment
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
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.