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Vocal Cord Paralysis

by Clarence T. Sasaki, MD

Vocal cord paralysis is the inability to move the muscles that control the vocal cords.

  • Paralysis can be caused by tumors, injuries, or nerve damage caused by infection or toxins.

  • Typical symptoms include voice changes and possible difficulty breathing.

  • The diagnosis is based on examination of the voice box (larynx), bronchial tubes, or esophagus.

  • Several procedures can help keep the airway from closing.

Vocal cord paralysis may affect one or both vocal cords. Females are affected more often than males.

Paralysis of one vocal cord can result from brain disorders, such as brain tumors, strokes, and demyelinating diseases (such as multiple sclerosis), or damage to the nerves that lead to the voice box (larynx). Nerve damage may be caused by noncancerous (benign) and cancerous (malignant) tumors; neck injury; surgery to the neck, such as surgical removal of the thyroid gland or spinal surgery; a viral infection of the nerves; Lyme disease; neurotoxins (substances that poison or destroy nerve tissue), such as lead, mercury, and arsenic; or the toxins produced in diphtheria. The cause is unknown for some people.

Paralysis of both vocal cords is a life-threatening disorder caused by surgery of the spine nearest the neck and surgical removal of the thyroid gland, insertion of a breathing tube into the windpipe (tracheal intubation), injury, and diseases that affect the nerves and muscles (such as myasthenia gravis).

Symptoms

Vocal cord paralysis prevents the vocal cords from opening and closing and may affect speaking, breathing, and swallowing. Paralysis may allow food and fluids to be inhaled (aspirated) into the windpipe (trachea) and lungs. If only one vocal cord is paralyzed, the voice is hoarse and breathy. Usually, the airway is not blocked because the normal cord on the other side opens sufficiently. When both vocal cords are paralyzed, the voice is reduced in strength but otherwise sounds normal. However, the space between the paralyzed cords is very small, and the airway is inadequate so that even moderate exercise causes difficulty in breathing and a harsh, high-pitched sound (stridor) with each breath.

Diagnosis

Doctors try to find the cause of the paralysis. They ask questions about all possible causes, including chronic exposure to heavy metals (arsenic, lead, and mercury), use of the drugs phenytoin and vincristine, history of a connective tissue disorder (such as Marfan syndrome), Lyme disease, sarcoidosis, diabetes, and alcoholism. In addition to asking questions about a person's medical history, doctors base the diagnosis on laryngoscopy. Laryngoscopy is examination of the larynx, with a thin, flexible viewing tube. Additional testing may include magnetic resonance imaging (MRI) or computed tomography (CT) of the head, neck, and chest; a scan of the thyroid gland; and x-rays of the esophagus (barium swallow).

Treatment

If only one side is paralyzed, an operation can be done to move the paralyzed vocal cord to the best position for more normal speech. The operation may involve inserting an adjustable spacer near the paralyzed cord or injecting a substance into the paralyzed cord to move the cords closer together, improve the voice, and prevent aspiration.

When both sides are paralyzed, keeping the airway open adequately is difficult. A tracheotomy (surgery to create an opening into the trachea by cutting through the front of the neck) may be needed. The tracheotomy opening may be permanent or may be used only when the person has an upper respiratory tract infection. In another procedure, called an arytenoidectomy, the vocal cords are permanently separated, thus widening the airway. However, this procedure may worsen voice quality. Laser removal of part of one or both vocal cords is preferred to arytenoidectomy and helps widen the airway. If done correctly, laser removal can preserve satisfactory voice quality and eliminate the need for a tracheotomy.

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  • MARQIBO KIT
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