Vocal Cord Paralysis
Vocal cord paralysis occurs when the nerve impulses to your voice box (larynx) are interrupted. This results in paralysis of your vocal cord muscle. 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. There are a number of causes of vocal cord paralysis, including nerve damage during surgery and certain cancers. Vocal cord paralysis can also be caused by a viral infection or a neurological disorder. The Mount Sinai Health System in New York City has considerable experience treating vocal cord paralysis. Our Eugen Grabscheid, MD Voice Center offers voice therapy and surgery for vocal cord paralysis.
Symptoms of vocal cord paralysis
Your vocal cords are two flexible bands of muscle tissue that sit at the entrance to your windpipe (trachea). When you speak, the bands come together and vibrate to make sound. The rest of the time, your 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. If both of your vocal cords are affected, you may have vocal difficulties, as well as significant problems with breathing and swallowing.
Symptoms of vocal cord paralysis include:
- Breathy vocal quality
- 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 gag reflex
- Ineffective coughing
If you have unexplained, persistent hoarseness for more than three or four weeks, or if you notice any unexplained voice changes or discomfort, see your doctor.
Causes of vocal cord paralysis
In vocal cord paralysis, the nerve impulses to your voice box (larynx) are interrupted, resulting in paralysis of the muscle. Doctors often don't know the cause of vocal cord paralysis. Known causes 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 non-cancerous, can grow in or around the muscles, cartilages or nerves of your voice box and can cause vocal cord paralysis.
- Inflammation. Arthritis or surgery can cause inflammation and scarring of the vocal cord joints or the space between the two vocal cord cartilages. This inflammation may prevent your vocal cords from opening and closing. The signs and symptoms of this disorder mimic vocal cord paralysis, even though the vocal cord nerves remain normal. In addition, some viral infections can inflame and 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. However, these conditions are more likely to cause vocal cord weakness than complete paralysis.
Factors that may increase your risk of developing vocal cord paralysis include:
- Undergoing throat or chest surgery. Thyroid, throat, or upper chest surgery increases your risk of vocal cord nerve damage. Sometimes the breathing tubes used during surgery or used to help you breathe if you're having serious respiratory trouble can damage your vocal cord nerves.
- Having a neurological condition. Certain neurological conditions, such as Parkinson's disease, multiple sclerosis or myasthenia gravis, may cause vocal cord weakness or paralysis.
Detection and Diagnosis
To further evaluate your voice problems, the following tests may be performed:
- Endoscopy. Your doctor will look at your vocal cords using a mirror or a thin, flexible tube (endoscope), or both. You may also have a test called videostrobolaryngoscopy, which uses a special scope containing a tiny camera at its tip or a larger camera connected to the scope's viewing piece. These special endoscopes allow your doctor to view your vocal cords directly or on a video monitor to determine the movement and position of your vocal cords, and whether one or both vocal cords are affected.
- Laryngeal electromyography. This test measures the electric currents in your voice box muscles. By looking at the pattern of the currents, your doctor can determine the degree of the problem and what types of treatment may be most effective. To obtain these measurements, your doctor typically inserts small needles into your vocal cord muscles through your neck.
- Blood tests and scans. Because a number of diseases may cause nerve damage, you may need additional tests to identify the cause of the paralysis. Tests may include blood work, lung function tests, X-rays, MRI or CT scans.
Treatments and Drugs
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, surgery, or both. In some instances, you may get better without surgical treatment. For this reason, your doctor may delay surgery for six months to a year from the beginning of your vocal cord paralysis. During this waiting period, 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 tensions in other muscles around the paralyzed vocal cord, and protect your airway during swallowing.
If your vocal cord paralysis symptoms don't fully recover on their own, surgical treatments may be offered to improve your ability to speak and to swallow. Surgical options include:
- Bulk injection. Paralysis of the nerve to your vocal cord will probably leave the vocal cord muscle thin and weak. To add bulk to a paralyzed vocal cord the laryngologist may inject your vocal cord with a substance such as body fat, collagen, or another approved filler. This added bulk brings the affected vocal cord closer to the middle of your voice box so that the opposite functioning and moving vocal cord can make closer contact with the paralyzed cord when you speak, swallow, or cough.
- Vocal cord repositioning. In this procedure, a surgeon moves a window of your own tissue from the outside of your voice box inward, pushing the paralyzed vocal cord toward the middle of your voice box. This allows your unimpaired vocal cord to better vibrate against its paralyzed partner.
- Tracheotomy. If both of your vocal cords are paralyzed and positioned closely together, your airflow will be decreased. In this situation, you'll have a lot of trouble breathing and require a surgical procedure called a tracheotomy. In a tracheotomy, an incision is made in the front of your neck and an opening created directly into the wind pipe (trachea). A breathing tube is inserted, allowing air to bypass the immobilized vocal cords.
We Can Help
Physicians at The Mount Sinai Hospital have extensive experience treating diseases of the larynx, including larynx cancer. U.S. News & World Report ranks Mount Sinai 10th in the nation for Ear, Nose and Throat/Head and Neck Surgery. Call us at 212-241-9425 to schedule an appointment. We are conveniently located on the Upper East Side of New York City.
Eugen Grabscheid MD Voice Center
Department of Otolaryngology –
Head & Neck Associates
5 East 98th Street
New York NY 10029