Vocal Cord Paralysis

The vocal cords or folds help you breathe, speak, and swallow. Moreover, it prevents food, drink, and saliva from entering the windpipe. Vocal cord paralysis, also known as recurrent laryngeal nerve palsy or vocal fold paralysis, is a health condition when you lose control of the muscles that move your vocal cords. It is caused by damage to the nerve impulses in the larynx (voice box). There could be many other reasons for vocal cord paralysis like surgical injury, malignancy, trauma, infection or Inflammation in the region.

Types of Vocal Cord Paralysis

The two types of vocal cord paralysis include:-

1. Bilateral Vocal Cord Paralysis: A life-threatening condition where both the vocal cords do not move 
2. Unilateral Vocal Cord Paralysis: A condition where only one cord either does not move completely or moves just a little. The paralysed cord does not vibrate with the other cord, making your voice unclear. This condition is more common than bilateral paralysis. 

 

Causes of Vocal Cord Paralysis

Usually, the exact cause of vocal cord paralysis cannot be determined. The most probable cause is the damage to your nerve impulses in the voice box. Other causes include:-

 

Injury and Trauma

Injury during surgery: Surgeries on or near the neck, such as the thyroid gland, neck, chest, and oesophagus, can damage the nerves in the voice box. 

Injury to the neck or chest: A trauma or injury to the neck or chest can damage the nerves that serve the voice box. 

 

Inflammatory Conditions and Infections

Infections: Infections like Lyme disease, herpes, and Epstein-Barr virus can cause inflammation and scarring, damaging the nerves in the voice box. 

 

Medical Conditions

Stroke: It may interrupt blood flow to the brain, damaging the part of the brain that sends messages to the voice box. 

Tumours: Malignant (cancerous) and benign (non-cancerous) tumours can push on the nerves in the voice box and damage them. 

Neurological conditions such as Parkinson’s disease and multiple sclerosis can cause vocal cord paralysis. 

Auto-immune diseases such as myasthenia gravis can cause transient or permanent paralysis of the vocal cords. 

Connective tissue disorders like Marfan syndrome can also cause vocal cord paralysis. 

 

Surgical Injury

Around  40% of BVC paralysis and 50% of VCP are caused by surgical Injury.

Bilateral vocal cord paralysis is generally caused by thyroid surgery.

Unilateral vocal cord paralysis is caused by carotid heart surgery, cervical spine surgical injury, and heart great vessel surgery.

 

Other causes of vocal cord paralysis include consuming poisonous substances such as lead and mercury. 

 

Symptoms of Vocal Cord Paralysis

The symptoms of vocal cord paralysis include:-

1. Changes in the voice (it may become scratchy or breathy)
2. Hoarseness
3. Noisy breathing
4. Shortness of breath  
5. Loss of vocal pitch
6. Coughing or choking while swallowing
7. Loss of gag reflex or pharyngeal reflex (contraction of the throat to prevent swallowing something foreign)
8. Frequent clearing of the throat
9. Vocal fatigue

Diagnosis of Vocal Cord Paralysis

To diagnose vocal cord paralysis, your doctor will begin by asking about your lifestyle and the symptoms you are experiencing. He/she will further check for some signs by listening to your voice and conducting the following diagnostic tests:-

Blood tests and imaging scans: Since several diseases can cause nerve damage, your provider may order a blood test, X-ray, MRI, and CT scan to determine the cause of the paralysis. An X-ray may be used to produce images of the oesophagus. A CT scan or MRI may show detailed pictures of your vocal cords, voice box, throat, brain, and chest. 

Laryngoscopy: In this test, the doctor inserts a long, thin tube with a camera at the end into your nose to examine the throat. The images on the monitor help the doctor look at your vocal cords and voice box. 

Laryngeal electromyography (LEMG): The doctor inserts small needles into your vocal cord muscles through the skin of your neck. It helps measure and record the electrical impulses in your voice box muscles. 

 

Treatment of Vocal Cord Paralysis

The treatment for vocal cord paralysis varies depending on the onset and severity of your symptoms. Sometimes, your condition may improve without surgical intervention. However, more severe vocal cord paralysis that causes difficulty swallowing may require surgery. 

 

Non-Surgical Treatments

Voice Therapy: Sometimes, vocal cord paralysis gets better on its own within a year. This is why doctors recommend voice therapy before surgery. It aims at restoring the communication between your brain and the larynx. The voice therapy sessions include special exercises to strengthen your vocal cords, protect the airway during swallowing, and improve breath and muscle control during speech. 

 

Surgical Treatments

The doctor may recommend surgery if your condition does not completely improve with voice therapy. 

Vocal cord injection: Vocal cord paralysis can result in the thinning and weakening of the vocal cord muscle. The doctor will inject a filler substance like collagen into your vocal cord to make the paralysed cord bulkier. The added bulk brings the paralysed vocal cord closer to the voice box, closing the gap between your vocal cords. 

Silicon implants: Also known as laryngeal framework surgery, thyroplasty, or medialisation laryngoplasty, the procedure involves using silicone implants in the voice box to reposition the vocal cord. The surgery requires only a small incision in the neck and is most commonly performed in older children or adults. 

Reinnervation (replacing the damaged nerve): The surgeon moves a healthy nerve from a different neck region to replace the damaged nerve in the voice box. Your voice may get better six to nine months after the procedure. Mostly helpful in children, the surgeon may decide to combine this procedure with a vocal cord injection. 

Vocal cord repositioning: Also known as phonosurgery, the surgery involves moving a window of your tissue inward from outside the larynx. It pushes the paralysed vocal cord in the middle of the voice box, allowing the normal vocal cord to vibrate against the paralysed one. The surgery helps produce sound through your larynx and breathe and swallow easily. 

Tracheotomy: The surgeon will perform a tracheotomy when both your vocal cords are paralysed. Closely positioned paralysed cords can decrease your airflow, causing breathing troubles. The surgery involves an incision in the front of your neck to insert a breathing tube in the windpipe (trachea). The tube opens the airway and enables you to breathe. It is performed only when your paralysed vocal cords prevent you from swallowing, breathing, or coughing, increasing your risk of suffocation. 

 

Please Note: The treatment approach is selected based on the severity of your vocal cord paralysis and your doctor’s opinion. 

How to Prepare for Doctor Consultation?

While preparing for your doctor’s consultation, make sure to

1. Take a prior appointment
2. Note down the symptoms you are experiencing
3. Write down your medical information
4. Enlist the medications, supplements, and vitamins you are taking
5. Write down the questions for your doctor
6. Take a friend or family member along
7.  
8. Here’s what you can expect from your doctor during the visit:-
9. When did you first notice the symptoms?
10. Did any event result in the development of these symptoms?
11. Are your symptoms continuous or occasional?
12. Does anything improve or worsen your symptoms?
13. What other medical conditions do you have?
14. Have you tried any treatment yet?

Here’s what you can ask the doctor about vocal cord paralysis

1. What is the cause of my vocal cord paralysis?
2. What diagnostic tests do I need to undergo?
3. Is this paralysis temporary or permanent?
4. Will I need surgery?
5. Can it be managed without surgery?
6. What are the available treatment options, and which do you recommend?
7. What are the side effects of these treatment options?
8. Will I need to restrict using my voice after the treatment? If yes, for how long?
9. Will I be generally able of speaking normally after the treatment?
10. What are the chances of recovery if I do not get treatment?

Conclusion

Treating the symptoms of vocal cord paralysis is usually possible. If you experience any symptoms, seek medical care. Though rare, bilateral vocal cord paralysis can be life-threatening. Consult your healthcare professional if you have a high risk of developing this condition. A treatment plan and voice therapy sessions can help you improve your ability to speak, eat, and swallow.