Vocal Cord Paralysis

What is Vocal Cord Paralysis?

Vocal cord paralysis happens when one or more of the nerves going to the larynx (voice box) stop working properly. These nerves connect to muscles in the larynx that are responsible for moving the vocal cords, so when something goes wrong with one of these nerves, it affects vocal cord function. As a result, the affected vocal cord loses the ability to open, close, or tense up appropriately, and this can have negative impacts on the voice, and in some cases on swallowing and even breathing.

Why Does Vocal Cord Paralysis Cause Symptoms?

When the nerve to the vocal cords is damaged, two things happen to the affected vocal cord. First, the vocal cord loses the ability to open and close, as well as the ability to tense up. Second, over time, the muscles of the vocal cord begin to atrophy (shrink), and this causes the vocal cord to shrink in size. The result of these two changes is that when you try to talk, the vocal cords cannot make full contact and there is a gap between them (the video below has great examples of this). The vocal cords also play a role in swallowing, so sometimes people may experience swallowing difficulties.

In rare cases, both vocal cords are paralyzed (known as bilateral vocal cord paralysis). This is a very serious condition. Since neither vocal cord is able to move, this means they cannot open enough to take a deep breath, so the most common symptom of bilateral vocal cord paralysis is difficulty breathing. This can be a minor issue in some people that is only experienced when they do exercise or strenuous activity, but in others, the difficulty breathing can be life threatening and require urgent surgery for treatment.

How Does Vocal Cord Paralysis Happen?

There are three main causes of vocal cord paralysis. It can happen as a result of nerve injury during surgery around the neck, lungs, heart, or esophagus; or from direct compression of a nerve in the neck or chest due to a growth such as a tumor; or it can happen spontaneously on its own without any known cause. We believe that this last scenario is most likely due to a virus that attacks the nerve and causes it to become inflamed and stop functioning. Don’t worry, vocal cord paralysis is NOT CONTAGIOUS.

How Is Vocal Cord Paralysis Treated?

The first step is determining the cause, and determining whether we think the paralysis is likely to be temporary or permanent. Although we haven’t yet found any proven ways to increase the chances of nerve recovery (there are some medications that MAY help, but the data is not conclusive), laryngologists (voice doctors) can perform a variety of procedures to REPOSITION the affected vocal cord, which can provide significant improvement of the voice. Common treatments for paralysis include vocal cord filler injections to temporarily bulk up and reposition  the vocal cords, permanent vocal cord repositioning procedures (such as type 1 thyroplasty/medialization laryngoplasty and arytenoid adduction), and reinnervation procedures where a functioning nerve is attached to the injured nerve to allow for nerve regrowth to occur.

Who Treats Vocal Cord Paralysis?

The most qualified people to treat vocal cord paralysis are ENT doctors with specialty training in the care of voice disorders, known as laryngologists (aka voice doctors). As a fellowship-trained laryngologist, Dr. Rafii has extensive experience in the care of vocal cord paralysis, and has expertise in all available techniques including filler injections, medialization laryngoplasty, arytenoid adduction, and vocal cord reinnervation. Dr. Rafii has special expertise in performing awake, in-office vocal cord filler injections, which can be done as a quick and simple procedure on the same day as your consultation in order to help get your voice back as quickly as possible. If you have been diagnosed with vocal cord paralysis, or you have hoarseness of unknown cause, call or message us today for a Comprehensive Voice Evaluation with Dr. Rafii.

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