Vocal Cord Paralysis: Causes, Symptoms, and Treatment

What is Vocal Cord Paralysis?

Vocal cord paralysis (also called vocal fold paralysis) occurs when one or both of your vocal cords cannot move properly. The vocal cords are two flexible bands of muscle tissue located in your voice box (larynx) that vibrate to produce sound when you speak. When these muscles become paralyzed, they cannot open, close, or adjust their tension normally, which affects your voice, breathing, and swallowing.

This condition can range from mild to severe. In some cases, it may cause only minor voice changes, while in others, it can lead to significant breathing difficulties or swallowing problems. Vocal cord paralysis can be temporary or permanent, depending on the underlying cause and treatment.

According to the Mayo Clinic, vocal cord paralysis is often caused by nerve damage and can affect people of all ages, though it is more common in adults.

Common Causes

Vocal cord paralysis occurs when the nerves that control the vocal cords (the recurrent laryngeal nerve and/or the vagus nerve) are damaged. Here are some of the most common causes:

• Surgical complications: Surgeries involving the thyroid, neck, chest, or spine can accidentally damage the nerves controlling the vocal cords. Thyroid surgery is one of the most common causes.
• Viral infections: Viruses like the common cold, influenza, or Epstein-Barr virus can cause inflammation and damage to the nerves.
• Neurological conditions: Disorders such as Parkinson’s disease, multiple sclerosis (MS), or stroke can affect nerve function and lead to vocal cord paralysis.
• Trauma or injury: Physical injury to the neck or chest, such as from a car accident or sports injury, can damage the nerves.
• Tumors: Both cancerous and non-cancerous tumors in the neck, chest, or brain can press on or damage the nerves controlling the vocal cords.
• Autoimmune disorders: Conditions like rheumatoid arthritis or lupus can cause inflammation that affects nerve function.
• Toxins or medications: Exposure to certain toxins or side effects from medications can lead to nerve damage.
• Idiopathic causes: In some cases, the exact cause of vocal cord paralysis cannot be determined (idiopathic paralysis).
• Intubation: Prolonged use of a breathing tube (intubation) during surgery or medical procedures can sometimes cause vocal cord damage.
• Chest or neck radiation: Radiation therapy for cancers in the neck or chest area can damage the nerves over time.

For more details on causes, refer to resources from the National Institutes of Health (NIH) or the Cleveland Clinic.

Associated Symptoms

The symptoms of vocal cord paralysis depend on whether one or both vocal cords are affected and the severity of the paralysis. Common symptoms include:

• Hoarseness or weak voice: Your voice may sound breathy, rough, or strained. This is often the first noticeable symptom.
• Voice fatigue: Your voice may tire quickly, especially after prolonged speaking.
• Difficulty speaking loudly: You may struggle to project your voice or be heard in noisy environments.
• Shortness of breath: If both vocal cords are paralyzed, they may not open properly, leading to breathing difficulties, especially during physical activity.
• Noisy breathing (stridor): A high-pitched sound when breathing in, which can indicate a narrowed airway.
• Frequent coughing or choking: Difficulty swallowing (dysphagia) can lead to coughing or choking, especially when eating or drinking.
• Ineffective cough: You may have trouble clearing your throat or coughing strongly.
• Frequent throat clearing: A sensation of something stuck in your throat may lead to constant throat clearing.
• Loss of vocal pitch or range: You may notice changes in your ability to sing or hit high or low notes.

If both vocal cords are paralyzed, symptoms can be more severe and may include significant breathing difficulties, especially during exertion or while lying down. This is a medical emergency and requires immediate attention.

When to See a Doctor

You should see a doctor if you experience any of the following:

• Hoarseness or voice changes that last longer than two to three weeks, especially if you are not sick or have no other explanation.
• Difficulty breathing or noisy breathing (stridor), which may indicate a narrowed airway.
• Trouble swallowing, frequent choking, or coughing while eating or drinking.
• Unexplained voice fatigue or loss of voice that does not improve with rest.
• A sensation of something stuck in your throat that does not go away.
• Pain or discomfort in the throat or neck that is not related to a cold or infection.

If you have a history of thyroid surgery, neck trauma, or neurological conditions, be especially vigilant about these symptoms. Early diagnosis and treatment can improve outcomes and prevent complications.

Diagnosis

Diagnosing vocal cord paralysis typically involves a combination of medical history, physical examination, and specialized tests. Here’s what you can expect during the diagnostic process:

Medical History and Physical Exam

Your doctor will ask about your symptoms, including when they started, how severe they are, and whether they are getting worse. They will also ask about any recent surgeries, illnesses, or injuries. A physical exam will include listening to your voice, checking your breathing, and examining your neck and throat.

Laryngoscopy

This is the primary test for diagnosing vocal cord paralysis. A laryngoscopy allows the doctor to visualize your vocal cords using a thin, flexible tube with a camera (endoscope) inserted through your nose or mouth. There are two types:

• Flexible laryngoscopy: Done in the doctor’s office using a local anesthetic spray to numb your nose or throat. The scope is passed through your nose or mouth to view the vocal cords.
• Rigid laryngoscopy: Performed in an operating room under general anesthesia, allowing for a more detailed examination. This may be necessary if the doctor needs to perform additional procedures.

Additional Tests

Depending on the suspected cause, your doctor may recommend further testing, such as:

• Blood tests: To check for infections, autoimmune disorders, or other underlying conditions.
• Imaging tests: CT scans, MRIs, or X-rays of the neck, chest, or brain to look for tumors, nerve damage, or other abnormalities.
• Electromyography (EMG): This test measures the electrical activity in the muscles of the vocal cords to assess nerve function.
• Swallowing studies: If you have difficulty swallowing, a modified barium swallow study or fiberoptic endoscopic evaluation of swallowing (FEES) may be performed to evaluate how well you can swallow.

For more information on diagnostic procedures, visit the American Speech-Language-Hearing Association (ASHA) or the American Academy of Otolaryngology.

Treatment Options

The treatment for vocal cord paralysis depends on the underlying cause, the severity of symptoms, and whether one or both vocal cords are affected. The goal of treatment is to improve voice quality, restore breathing, and prevent complications like aspiration (food or liquid entering the airway). Here are the main treatment options:

Voice Therapy

For mild cases, voice therapy with a speech-language pathologist (SLP) can be very effective. The SLP will teach you exercises to strengthen your vocal cords, improve breath support, and compensate for the paralysis. Techniques may include:

• Breathing exercises to improve vocal cord closure.
• Pitch and resonance exercises to enhance voice quality.
• Swallowing therapy to reduce the risk of choking or aspiration.

Voice therapy is often the first line of treatment and can be used alone or in combination with other treatments.

Medications

If the paralysis is caused by an infection or inflammation, your doctor may prescribe:

• Antiviral or antibiotic medications: To treat underlying infections.
• Steroids: To reduce inflammation around the nerves.

Surgical Interventions

If voice therapy and medications are not sufficient, surgical options may be considered. These include:

• Vocal cord injection: A temporary or permanent filler (such as collagen, fat, or a synthetic material) is injected into the paralyzed vocal cord to bulk it up and improve closure. This can help with voice and swallowing issues.
• Thyroplasty: A surgical procedure where an implant is placed in the voice box to reposition the paralyzed vocal cord, allowing it to close more effectively.
• Arytenoid adduction: This surgery repositions the arytenoid cartilage (a small structure in the larynx) to improve vocal cord closure.
• Tracheotomy: In severe cases where both vocal cords are paralyzed and breathing is compromised, a tracheotomy (a surgical opening in the neck to bypass the blocked airway) may be necessary.
• Reinnervation: A newer surgical technique where a healthy nerve is connected to the paralyzed vocal cord to restore movement. This is typically considered in select cases.

Home and Lifestyle Remedies

In addition to medical treatments, the following strategies can help manage symptoms at home:

• Stay hydrated: Drink plenty of water to keep your throat lubricated.
• Avoid irritants: Refrain from smoking, alcohol, and caffeine, which can dry out or irritate your vocal cords.
• Use a humidifier: Adding moisture to the air can help soothe your throat.
• Rest your voice: Avoid straining your voice by speaking loudly or for long periods.
• Practice good vocal hygiene: Avoid whispering (which strains the vocal cords) and try to speak at a normal volume.

Prevention Tips

While not all cases of vocal cord paralysis can be prevented, you can reduce your risk by taking the following steps:

• Seek prompt treatment for infections: Viral or bacterial infections that affect the throat or respiratory system should be treated early to prevent nerve damage.
• Be cautious with surgeries: If you are undergoing thyroid, neck, or chest surgery, discuss the risks of nerve damage with your surgeon. Choose an experienced surgeon to minimize complications.
• Protect your neck and chest: Wear seatbelts, use proper safety equipment during sports, and take precautions to avoid trauma to the neck or chest.
• Manage chronic conditions: If you have a neurological disorder like Parkinson’s disease or MS, work with your healthcare team to manage symptoms and reduce the risk of complications.
• Avoid smoking and limit alcohol: Smoking can irritate the vocal cords and increase the risk of nerve damage, while excessive alcohol can dry out the throat.
• Stay hydrated: Drinking enough water keeps your vocal cords lubricated and healthy.
• Use your voice wisely: Avoid straining your voice by shouting or speaking for extended periods without rest.

For more prevention tips, refer to guidelines from the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO).

Emergency Warning Signs

Vocal cord paralysis can sometimes lead to life-threatening complications, especially if both vocal cords are affected. Seek immediate medical attention if you experience any of the following emergency warning signs:

• Severe difficulty breathing: Struggling to catch your breath, gasping for air, or feeling like you cannot get enough oxygen.
• Blue lips or fingertips (cyanosis): A sign that your body is not getting enough oxygen.
• Severe choking or inability to swallow: If you cannot swallow saliva or are choking frequently, this may indicate a blocked airway.
• High-pitched breathing sounds (stridor): A loud, squeaky noise when breathing in, which suggests a narrowed airway.
• Confusion or loss of consciousness: A lack of oxygen can lead to confusion, dizziness, or fainting.
• Inability to speak or make sounds: Sudden loss of voice accompanied by breathing difficulties.

If you or someone else experiences these symptoms, call emergency services or go to the nearest emergency room immediately. Do not wait to see if symptoms improve on their own.