How Vocal Cord Paralysis Can Affect Your Life

Vocal cord paralysis occurs when one or both vocal cords are not able to move. Your vocal cords are two elastic-type bands found in your larynx (voice box), at the top of your trachea (windpipe). The damaged vocal cords remain frozen or stuck, so they do not open and close as they should.

Vocal cord paralysis can have an impact on your health as well as your daily life. This ailment can make it hard to speak, swallow, or breathe. The effect can hinder the way you express yourself to others at home, at work, and socially,

Treatment varies based on the cause of the problem. Some cases of vocal cord paralysis resolve on their own. At the other extreme, some cases need surgery to correct the problem and prevent choking.

This article describes vocal cord paralysis, its symptoms, causes, risk factors, and diagnosis. It also details treatments and outlooks for those who have it.

What Does Vocal Cord Paralysis Feel Like?

The sensations caused by vocal cord paralysis vary based on the severity of your condition. It can also vary based on whether the damage involves one vocal cord (unilateral paralysis) or both vocal cords (bilateral paralysis).

Unilateral paralysis is the most common type involving the left vocal cord. Though rare, bilateral paralysis causes more severe problems and can be life-threatening.

Generally, the condition does not cause feelings of pain in your vocal cords, you will likely notice a range of different sensations that affect normal breathing:

• Difficulty swallowing or choking while swallowing
• A sensation that your food or drink is going down your windpipe
• Dyspnea (difficulty breathing)
• A feeling of breathlessness when you talk or exercise
• Fatigue from exerting to draw more air into your lungs to achieve a voice
• Persistent mucous in your throat that doesn't clear, leading to frequent throat clearing
  

What Causes Vocal Cord Paralysis?

Most cases of vocal cord paralysis occur as a result of changes related to vocal cord anatomy. They often involve abnormal functions of the primary nerves that control your voice box (the vagus nerve and its nerve branches, the recurrent laryngeal nerve, and the superior laryngeal nerve). Damage to the recurrent laryngeal nerve, which controls the vocal cord's motion, is involved in most cases of vocal cord paralysis.

These nerves help your vocal cords do the following:

• Open for air to pass during breathing
• Come together and vibrate to make sounds when you cough, laugh, or speak (phonation)
• Close tightly to protect to prevent food, drink, and saliva from entering your windpipe, causing you to choke

In extreme cases of bilateral vocal cord paralysis, your airway becomes obstructed by frozen vocal cords because they can't completely open to allow normal breathing. It leads to aspirating (inhaling) food or liquid and life-threatening choking because your vocal cords can't completely close to protect your airway.

When you inhale food or liquid into your lungs, you increase your risk of aspiration pneumonia. This condition involves the inflammation and infection of your lungs or large airways. It is a life-threatening illness that causes choking that can lead to death.

Up to 50% of vocal cord paralysis cases are labeled as idiopathic (having no known cause). One theory says that they may occur due to nerve inflammation from the common cold virus.

When a cause is identifiable, it usually involves one of the following issues:

• Malignant (cancerous) and benign (non-cancerous) tumors of the skull base, neck, and chest that compress the nerves that control your voice cords
• Injury during surgery in your neck (thyroid gland, cervical spine, carotid artery) or your chest (lungs, esophagus, large blood vessels, or heart)
• Inflammation from infections like Lyme disease that injures the vagus nerve or its nerve branches
• Autoimmune diseases such as rheumatoid arthritis that cause inflammation and scarring of the vocal cord joints
• Neurological conditions, such as a stroke, multiple sclerosis, or Parkinson's disease, that damage the part of your brain that sends messages to your voice box
• Blunt trauma to your neck or chest as a result of physical injury
• Breathing tube/intubation, a rare injury to the recurrent laryngeal nerve that occurs when a breathing tube is inserted to assist with breathing for an extended period
  

Vocal Cord Paralysis Treatment

The type of treatment needed for your vocal cord paralysis depends on the cause of your condition, whether one or both vocal cords are involved, and how the damage affects a specific nerve.

The two treatment strategies used to treat voice cord paralysis are voice therapy and surgery.

Voice Therapy

Many cases of unilateral vocal cord paralysis are temporary problems caused by an inflamed nerve that was not cut or damaged. These cases often resolve on their own within a year without treatment. This is why permanent treatments like surgery are often delayed for at least a year after the onset of symptoms.

Voice therapy is the first treatment used while you wait for your voice to return. Similar to the process of physical therapy, voice therapy uses guided exercises to help you learn the following:

• Guided exercises to strengthen your vocal cords
• How to use your moving vocal cord to compensate for the paralyzed one
• Ways to use your voice differently with strategies like speaking slower or improving breathing control when you speak
• How to protect your airway when you swallow
  

Surgery

Vocal cord surgery involves treatments that can help improve your ability to speak and swallow when your vocal cord paralysis is permanent. The different techniques include the following:

• Bulk injection: This technique uses the injection of a filling material like body fat, collagen, or another approved material to add bulk to a vocal cord that has been thinned and weakened by paralysis. The effect helps to close the gap between your vocal cords to help restore more normal speech for as long as the material remains effective.
• Laryngeal framework surgery (also called medialization laryngoplasty or thyroplasty): This permanent treatment involves helping both cords close and vibrate better by insertingd an implant into your voice box. This helps to move your paralyzed vocal cord toward the middle of your voice box so your healthy vocal cord can better vibrate against the one that is damaged.
• Laryngeal reinnervation: This procedure repairs the damaged nerve supply to the paralyzed vocal cord by using parts of other unaffected nerves to restore better speech and swallowing.
• Tracheotomy: Also called a tracheostomy, it treats bilateral vocal cord paralysis by providing an alternative airway when paralyzed vocal cords sit too close together for normal airflow. It involves making an incision in the front of your neck and through into your trachea. A breathing tube may be inserted through the opening, which allows air to bypass the immobilized vocal cords for breathing and a functional voice.
  

Other Symptoms of Vocal Cord Paralysis

Symptoms of vocal cord paralysis typically involve voice changes or discomfort. It can begin as unexplained, persistent hoarseness that lasts for more than three or four weeks. Other potential signs and symptoms include the following:

• Changes to the voice – it may become more “breathy,” like a loud whisper
• Hoarseness, huskiness
• Noisy breathing
• Changes to vocal pitch
• Coughs that do not clear the throat properly
• When swallowing solids or liquids, the patient might choke (including saliva sometimes)
• While speaking, the sufferer may have to catch their breath more often than usual
• Voice volume may be affected – the patient may not be able to raise their voice
• Pharyngeal reflex (gag reflex)
  

Possible Complications

In addition to the physical changes that affect your speech, voice box paralysis can increase your risk of the following severe complications:

Breathing

The most severe complications occur from bilateral vocal cord paralysis, which can increase your risk of suffocation when the cords are paralyzed close together. This creates an obstruction that blocks the airflow into your trachea and lungs.

Aspiration

In extreme cases of bilateral vocal cord paralysis, frozen vocal cords can lead to aspiration (inhaling food or liquid into your lungs). This can increase your risk of aspiration pneumonia. This condition involves the inflammation and infection of your lungs or large airways. It is a life-threatening illness that causes choking that can lead to death.

Physococial distress

Research indicates that people who have a voice disorder as that which occurs with vocal cord paralysis have a significant prevalence of psychosocial distress. This can include the onset of the following psychological conditions in people who did not have a previous issue:

• Depression
• Anxiety
• Somatic concerns (extreme focus on physical symptoms)
  

How Vocal Cord Paralysis Is Diagnosed

The diagnosis of vocal cord paralysis is typically made by an otolaryngologist (a physician who specializes in ear, nose, and throat disorders. Your initial consultation will involve a discussion of your symptoms and their onset to determine the cause of your problem.

The diagnosis of vocal paralysis usually involves one or more of the following procedures, depending on your symptoms:

• Endoscopy: uses an endoscope (a thin, flexible tube with a light ad camera at the end) called an endoscope that allows your provider to look into your throat at your vocal cords.
• Laryngeal electromyography: measures the muscle activity and electrical impulses of the nerves in your larynx by taking readings from electrodes (very fine needles) inserted into your vocal cord muscles through your neck
• Blood tests: These identify whether vocal cord paralysis is linked to an underlying medical condition
• Computed tomography (CT) scan: An imaging technique that uses multiple X-rays to create a three-dimensional image of the area surrounding your vocal cords
• Magnetic resonance imaging (MRI): An imaging technique that produces two-or-three dimensional images of your organs, tissues, and skeleton surrounding your head and neck
  

Vocal Cord Paralysis Risk Factors

Any adult or child can develop vocal cord paralysis. Having certain conditions can increase your risk of developing vocal cord paralysis:

• A recent viral illness followed by the onset of a breathy voice.
• Past cranial, head and neck, thyroid, thoracic, cardiac, and esophageal surgery, due to the potential for nerve damage near the area of surgical treatment
• Having one or more of the following procedures:, Radiation therapy, angiography, and neurotoxic drug administration
• Being elderly and having other risk factors for one of the following types of cancer: lung cancer, esophageal cancer, thoracic cancers (cancers that affect your chest or thoracic cavity), and thyroid cancer
• A growth or tumor along the course of the vagus nerve, especially at the base of your skull, neck, or chest
• Having a neurological condition such as: Parkinson's disease, myasthenia gravis, and multiple sclerosis
  

Outlook for Vocal Cord Paralysis

Many factors determine the outlook for a case of vocal cord paralysis. The effect of voice changes and airway and swallowing problems vary based on the type of vocal cord paralysis and its severity.

Other factors, including your age, underlying conditions, and psychological perspective can impact the effect that this problem has on your physical and mental well-being.

If you depend on your voice for your career, as in professional singing, unilateral vocal cord paralysis can be devastating. However, if you use your voice for basic communication, its effect on your daily life can be minimal.

Though rare, bilateral vocal cord paralysis can require living indefinitely with a tracheotomy to maintain an open airway.

Summary

Vocal cord paralysis occurs when one or more vocal cords become frozen in place. The problem can prevent the flow of air, hinder normal speech, and leave your airway at risk of choking.

This problem results when the nerves that control your vocal cords become damaged by disease, surgery, a tumor, or a breathing tube. If the damage is minor, the problem may heal on its own without treatment. Severe cases may need surgery to correct the damaged vocal cord and move it closer to the healthy one.

The impact of vocal cord paralysis can vary based on the type of problem that occurs. Though having two damaged vocal cords is rare, it is the most severe type of this problem and needs prompt treatment.