Introducing: Ask a Doctor
At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.
That’s why our department’s introducing Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.
Today, we discuss vocal cord paralysis.
Prepared by: Stephanie Horton, MS4
Reviewed by: Dr. Sandra Stinnett
What is Vocal Cord Paralysis?
Vocal fold paralysis is a condition where the muscles in your larynx, or voice box, do not move as they are supposed to for one reason or another.
These muscles are responsible for producing the sounds we make when we speak, protecting our airway when we swallow food or drink, making changes in our voice when we sing or cough, and a variety of other daily activities. The muscles in your voice box are controlled by nerves from your brain, which tell the muscles when they should open or close, depending on what you are trying to accomplish.
The nerve that controls most of your voice box muscles is called the Recurrent Laryngeal Nerve. When this nerve becomes injured, your muscles lose the connection to your brain that tells them to open or close your voice box, leading to breathy voice with increased fatigue with speaking, shortness of breath, and trouble swallowing/choking, particularly with liquids.
What are the causes of Vocal Cord Paralysis?
- History of surgeries in the head/neck
- Injury due to intubation (placement of a breathing tube for surgery)
- History of radiation treatment to the head/neck
- Cancers of the head/neck
- Multiple Sclerosis
- Autoimmune conditions
- Complications from diabetes
- Idiopathic (nerve injury without an identifiable cause)
Figure 1. Image showing different degrees of vocal cord paralysis. From Unilateral Vocal Fold Immobility.
How do we treat it?
Treatment will vary based on whether only one side or both sides of your vocal cords are paralyzed: unilateral paralysis or bilateral paralysis.
For unilateral paralysis:
Typically, we will recommend voice therapy to help you learn how to better use the voice you have while also preventing further injury. Surgical treatment options include: 1) injection laryngoplasty, 2) medialization laryngoplasty, and 3) arytenoid adduction.
1) Injection laryngoplasty:
This can be done in the clinic with local anesthesia or in the operating room under general anesthesia. This treatment involves injecting a substance into your paralyzed vocal cord to add bulk to it in order to allow your vocal cords to come together and produce sound. The effects of each injection can last between 1 month to 1 year, depending on the substance used.
2) Medialization laryngoplasty (Type I Thyroplasty):
This is done in the operating room. We make a small incision in your neck and place an implant near your vocal cords, which will bring your paralyzed vocal cord closer to the middle. This allows your vocal cords to come together again in order to produce sound. This is done with minimal sedation so we can hear the quality of the voice while the implant is being placed.
3) Arytenoid adduction:
We often do this in combination with medialization laryngoplasty (see above). The arytenoid cartilage is the anchor point for most of the muscles in our voice box, and sometimes, we can rotate this cartilage in order to bring the vocal cords closer together.
For bilateral paralysis:
This results in a narrowing of the airway due to the inability of the vocal folds to open. Usually, the voice is not significantly impacted, however patients will have difficulty breathing. The overall goal of treating bilateral vocal cord paralysis is to provide an adequate airway to be able to breath comfortably.
This is the best option for treatment. A tracheostomy is performed under general anesthesia, where your doctor will make an incision in your neck in order to insert a breathing tube in your trachea or airway. This will allow you to move air into and out of your lungs by bypassing the paralysis in your voice box up above.
2) Transverse cordotomy:
Surgical treatment where your doctor will remove part of your vocal cords on one side in order to allow more space for air to pass through.
Surgical treatment where your doctor will remove part of your arytenoid cartilages – which is the area where the vocal cords are anchored. This may be done with the transverse cordotomy to provide a larger space for air to move through.
4) Posterior cricoid split with rib graft:
Surgical treatment that widens the airway by splitting the ring of the airway and placing a piece of the patient’s rib to increase the space between the paralyzed vocal folds
5) Suture lateralization of the vocal fold:
A suture is placed through the neck, into the vocal fold, to lateralize one vocal fold and open up the airway. The suture is buried under the skin. This may be revered by simply cutting and removing the suture in the event that the vocal folds regain function.
What are some potential complications?
Please note: every patient’s situation is different, and we recommend that you discuss your options with your doctor to decide which treatment is best for you!
Possible complications for these procedures include postoperative swelling, scar tissue formation at the site of surgery, worsening voice, and difficulty swallowing.