Vocal Cord Paralysis

Vocal cord paralysis is a voice disorder that occurs when one or both of the vocal cords (or vocal folds) do not open or close properly. Symptoms can range from mild to life threatening if there is an airway obstruction.

The most common causes of vocal cord paralysis are surgical traumas to the neck and chest. Other causes include head trauma, stroke, neurological conditions such as multiple sclerosis or Parkinson’s disease, neck injury, lung or thyroid cancer, a tumor pressing on a nerve or a viral infection. However, in many cases, the cause is unknown.

Symptoms usually include changes in voice quality. If only one vocal cord is affected, the voice is usually hoarse or breathy, and patients often choke on liquid (known as aspiration). Paralysis to both vocal cords usually causes people to have difficulty breathing because the air passage through the larynx is blocked.

There are several methods for treating vocal cord paralysis, including surgery and voice therapy. In some cases, the voice returns without treatment during the first year after damage. For that reason, doctors often delay corrective surgery for at least a year to be sure the voice does not recover spontaneously. During this time, the suggested treatment is usually voice therapy, which may involve exercises to strengthen the vocal cords or improve breath control during speech. Sometimes, a speech-language pathologist must teach patients to talk in different ways.

Laryngeal electromyography (EMG) is a test that involves inserting a needle into the muscles of the larynx to detect the neuromuscular function of the vocal folds. This test, which is done by an otolaryngologist together with a neurologist, can help determine the likelihood that a paralyzed vocal fold will recover or not.

Surgical treatment for one paralyzed vocal cord focuses on improving the vocal cord’s ability to close. Henry Ford’s otolaryngologists specialize in several state-of-the-art procedures to treat a paralyzed vocal cord, including:

Vocal fold medialization: Surgically implanting material inside the larynx to move the paralyzed vocal fold closer to the midline of the larynx.

Arytenoid adduction: The muscles that move vocal folds are attached to the arytenoid, which is a small piece of cartilage located at the back of the vocal cords. With this procedure, the arytenoid is moved closer toward the middle of the larynx.

Injection procedures: Injection of material (cymetra, fat, gelfoam, Teflon) into the larynx to push the vocal fold toward the midline.

When both cords are affected, the problem is less often voice and more that there is not enough room between the vocal cords for breathing. Surgical treatment is aimed at opening the airway by removing a portion of the vocal cord and/or arytenoid cartilage. While this procedure usually improves the opening of the airway, some vocal quality is sacrificed.

Following any procedure, the patient may need voice therapy to regain the strength of their vocal cords and speech.