About Vocal Cord Paralysis

Overview

Vocal cord paralysis, also known as vocal fold paralysis, is a condition where one or both of the folds of tissue in the voice box, called the vocal cords, are unable to move properly. This can affect a person's ability to speak, breathe, and swallow. The condition is caused by damage to the nerves that control the vocal cords or by brain damage. Symptoms of vocal cord paralysis can include hoarseness, vocal fatigue, reduced speech volume, pain in the throat when speaking, and difficulty swallowing. In severe cases, it can even lead to choking and respiratory problems. Treatment for vocal cord paralysis may involve surgery to restore communication between the nerves in the vocal cords and the brain. Voice therapy can also be helpful in certain cases.

Causes and Risk Factors

Vocal cord paralysis, also known as vocal fold paralysis, can be caused by various factors. Vocal cord paralysis is often triggered by a medical event or other health conditions that may lead to misfiring or damaged nerves. Here are the causes of vocal cord paralysis:

• Injury to the chest or neck
• Stroke
• Tumors around or in the cartilages, nerves, or muscles of the voice box
• Inflammation or scarring of the vocal cord joints
• Multiple sclerosis (MS)
• Parkinson's disease

Risk factors associated with vocal cord paralysis include:

• History of chest and throat surgery: This includes surgeries on the thyroid, esophagus, and chest.
• Neurological conditions: Individuals with neurological conditions like Parkinson's disease and multiple sclerosis are more likely to experience vocal cord paralysis due to nerve damage.
• Intubation over age 50: A small study indicated that having intubation (insertion of a tube into the airway) over the age of 50 and being intubated for more than six hours increased the risk of developing vocal cord paralysis after surgery.

Symptoms

The most common early symptoms of vocal cord paralysis, also known as vocal fold paralysis, include:

• Hoarseness
• Difficulty swallowing
• Breathing difficulty
• Changes in vocal pitch
• Coughs that do not clear the throat properly

As vocal cord paralysis progresses or becomes more severe, additional symptoms may occur, including:

• Complete loss of speaking ability
• Difficulty swallowing that may lead to frequent choking while eating or drinking
• Noisy breathing that may involve a high-pitched wheezing sound
• Changes in the quality of voice and difficulty communicating

It's important to note that if you experience any significant changes in your speech pattern or the quality of your voice, it's recommended to contact an ear, nose, and throat doctor for an evaluation. If you're choking due to paralyzed vocal cords and can't speak, seek emergency medical assistance immediately.

Diagnosis

To diagnose vocal cord paralysis (also known as vocal fold paralysis), doctors may perform several examinations, tests, and procedures. These include:

• Medical history and physical examination: The doctor will ask about the patient's symptoms and how long they have been experiencing problems with their voice. They may also listen to the patient's voice and look for signs of vocal cord paralysis.
• Endoscopy: This procedure involves using a long, thin, flexible tube called an endoscope to examine the vocal cords. The doctor can get a clear view of the vocal cords on a monitor.
• Laryngeal electromyography (LEMG): LEMG measures the strength of the neuromuscular signal from the brain to the muscles controlling the vocal folds (cords). Small needles are inserted into the vocal cord muscles through the skin of the neck. During this test, the doctor will ask the patient to perform various tasks that would normally activate these muscles.

In addition to these common diagnostic tests, there are additional examinations, tests, and procedures that can help determine the stage or severity of vocal cord paralysis, including:

• Ultrasonographic assessment: This involves using ultrasound to assess vocal cord movement. Two different procedures can be used: the conventional middle transverse procedure and the novel lateral vertical procedure.
• Blood tests: The doctor may order blood tests to help determine the underlying cause of vocal cord paralysis.
• Imaging scans: X-rays, CT scans, or MRI scans may be ordered to further investigate and identify potential causes of vocal cord paralysis.

It's important to note that each case of vocal cord paralysis is unique, and additional examinations or tests may be required based on individual circumstances.

Treatment Options

The goals of treatment for vocal cord paralysis are to improve voice function, ensure adequate breathing, and prevent complications such as aspiration (inhaling food or liquid into the lungs) and swallowing difficulties. Here are the different treatment options and how they work to achieve these goals:

• Voice therapy: This is like physical therapy for the vocal cords. A certified speech-language pathologist will guide you through exercises and activities to strengthen your vocal cords, improve breath control while speaking, and prevent tension in other muscles near the affected vocal cord(s). The goal is to restore nerve communication between your brain and your larynx, improving voice function.
• Surgery:
• Vocal cord repositioning: This surgical procedure involves repositioning and reshaping the vocal cord to improve voice functions. It aims to restore proper movement of the vocal cords.
• Tracheotomy: If both vocal folds are affected and very close to each other, breathing can be difficult due to decreased airflow. In this procedure, a breathing tube is inserted through an incision made in front of the neck, bypassing the paralyzed vocal cords. This allows for proper breathing by creating an alternate airway.
• Vocal cord injection: Injectable materials such as fat, collagen, or fillers are used to make the affected vocal cord bulkier and easier to move. The injection is performed through the skin covering your larynx using a laryngoscope.

It's important to note that some cases of vocal cord paralysis may resolve on their own within a year without any intervention. In such cases, monitoring the condition may be recommended before considering any treatment options.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.

Progression or Complications

The natural progression of vocal cord paralysis can vary depending on the individual and the underlying cause. In some cases, the paralysis may resolve on its own over time. However, in many cases, medical intervention is necessary to restore communication between the nerves in your vocal cords and your brain.

Complications of vocal cord paralysis commonly occur and can include:

• Hoarseness
• Breathing difficulties
• Difficulty swallowing
• Aspiration (food or liquid entering the lungs): This can lead to pneumonia or other respiratory infections.
• Communication challenges

It's important to note that while there are treatment options available for vocal cord paralysis, it's always best to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan. They will be able to assess your specific situation and recommend the most appropriate course of action for you.