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Vocal Cord Paralysis

Vocal fold (or cord) paresis and paralysis result from abnormal nerve input to the voice box muscles (laryngeal muscles).  Paralysis is the total interruption of nerve impulse resulting in no movement of the muscle; Paresis is the partial interruption of nerve impulse resulting in weak or abnormal motion of laryngeal muscle(s).

Vocal fold paresis/paralysis can happen at any age - from birth to advanced age, in males and females alike, from a variety of causes. The effect on patients may vary greatly depending on the patient's use of his or her voice: A mild vocal fold paresis can be the end to a singer's career, but have only a marginal effect on a computer programmer's career.

Causes

Vocal cord paralysis commonly results from the accidental severing of the recurrent laryngeal nerve or of one of its extralaryngeal branches during thyroidectomy.

Other causes include pressure from an aortic aneurysm or from an enlarged atrium (in patients with mitral stenosis), bronchial or esophageal carcinoma, hypertrophy of the thyroid gland, trauma (such as neck injuries) and intubation, and neuritis due to infections or metallic poisoning. Vocal cord paralysis can also result from hysteria and, rarely, lesions of the central nervous system.

Signs and symptoms

Unilateral paralysis, the most common form, may cause vocal weakness and hoarseness. Bilateral paralysis typically produces vocal weakness and incapacitating airway obstruction if the cords become paralyzed in the adducted position.

Diagnosis

Patient history and characteristic features suggest vocal cord paralysis. Visualization by indirect laryngoscopy shows one or both cords fixed in an adducted or partially abducted position and confirms the diagnosis.

Treatment

In unilateral vocal cord paralysis, treatment consists of injection of Teflon into the paralyzed cord, under direct laryngoscopy. This procedure enlarges the cord and brings it closer to the other cord, which usually strengthens the voice and protects the airway from aspiration.

Thyroplasty also serves to medialize the vocal cord, but in this procedure an implant is placed through a neck incision. The ansa cervicalis nerve transfer allows for reinnervation of the muscles of the vocal cord. Bilateral cord paralysis in an adducted position necessitates tracheotomy.

Alternative treatments for adults include encloscopic arytenoidectomy to
open the glottis, and lateral fixation of the arytenoid cartilage through an external neck incision. Excision or fixation of the arytenoid cartilage improves airway patency but produces residual voice impairment. Treatment of hysterical aphonia may include psychotherapy and hypnosis.

Coping skills

Vocal cord paralysis can be frustrating and sometimes debilitating, especially since your voice is so important to your personality. Speak to a speech therapist about things you can do to help you develop the skills you need to communicate. Even if you're not able to regain the voice you once had, speech therapy can help you learn effective ways to compensate.