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Vocal Cord Paralysis

By

Clarence T. Sasaki

, MD, Yale University School of Medicine

Last full review/revision Jan 2020| Content last modified Jan 2020
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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.

  • 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 Overview of Demyelinating Disorders Most nerve fibers inside and outside the brain are wrapped with many layers of tissue composed of a fat (lipoprotein) called myelin. These layers form the myelin sheath. Much like the insulation... read more (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; many types of surgery that involve the neck or chest, such as surgical removal of the thyroid gland, spinal surgery, or heart surgery; a viral infection of the nerves; Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by Borrelia species, primarily by Borrelia burgdorferi and sometimes by Borrelia mayonii in the United States. These spiral-shaped bacteria... read more Lyme Disease ; neurotoxins (substances that poison or destroy nerve tissue), such as lead, mercury, and arsenic; or the toxins produced in diphtheria Diphtheria Diphtheria is a contagious, sometimes fatal infection of the upper respiratory tract caused by the gram-positive, rod-shaped bacteria (see figure How Bacteria Shape Up) Corynebacterium diphtheriae... read more Diphtheria . The cause is unknown for some people.

Paralysis of both vocal cords is a life-threatening disorder because the vocal cords cannot open enough to let air through properly. This paralysis can be caused by surgery of the spine through the front of the neck, surgical removal of the thyroid gland, insertion of a breathing tube into the windpipe (tracheal intubation), or diseases that affect the nerves and muscles (such as myasthenia gravis Myasthenia Gravis Myasthenia gravis is an autoimmune disorder that impairs communication between nerves and muscles, resulting in episodes of muscle weakness. Myasthenia gravis results from malfunction of the... read more ).

Vocal Cord Paralysis

Paralysis may affect one vocal cord (one-sided) or both vocal cords (two-sided—not shown).

Vocal Cord Paralysis

Symptoms of Vocal Cord Paralysis

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 of Vocal Cord Paralysis

  • Laryngoscopy

  • Imaging studies

Doctors try to find the cause of the vocal cord 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 Overview of Connective Tissue Disorders in Children Connective tissue is the tough, often fibrous tissue that binds the body's structures together and provides support and elasticity. Muscles, bones, cartilage, ligaments, and tendons are built... read more (such as Marfan syndrome Marfan Syndrome Marfan syndrome is a rare hereditary disorder of connective tissue, resulting in abnormalities of the eyes, bones, heart, blood vessels, lungs, and central nervous system. This syndrome is caused... read more Marfan Syndrome ), Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by Borrelia species, primarily by Borrelia burgdorferi and sometimes by Borrelia mayonii in the United States. These spiral-shaped bacteria... read more Lyme Disease , sarcoidosis Sarcoidosis Sarcoidosis is a disease in which abnormal collections of inflammatory cells (granulomas) form in many organs of the body. Sarcoidosis usually develops in people aged 20 to 40, most often people... read more Sarcoidosis , diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more , and alcoholism Alcohol Alcohol (ethanol) is a depressant. Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma, and death. Genetics and personal characteristics may... read more .

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

  • X-rays of the esophagus (barium swallow)

Treatment of Vocal Cord Paralysis

  • Surgery

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.

Drugs Mentioned In This Article

Generic Name Select Brand Names
MARQIBO KIT
DILANTIN
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