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When the nerve impulses to your voice box (larynx) are interrupted, vocal cord paralysis occurs. The vocal cord muscles are paralyzed as a result.
Vocal cord paralysis can impair your ability to communicate and even breathe. Because your vocal cords, also known as vocal folds, do more than merely make sound. They also protect your airway by keeping food, drink, and even saliva from entering your windpipe (trachea) and choking you.
Nerve injury during surgery, viral infections, and some malignancies are also possible causes. Surgery and, in certain cases, voice treatment are used to treat vocal cord paralysis.
WHAT ARE THE SYMPTOMS OF VOCAL CORD PARALYSIS?
Your voice cords are two flexible bands of muscle tissue located near the mouth of your windpipe (trachea). When you talk, the bands combine and vibrate to produce sound. The vocal chords are relaxed in an open position the rest of the time, allowing you to breathe.
Most cases of vocal cord paralysis affect only one vocal cord. Both of your vocal chords being paralyzed is a rare but serious ailment. This can result in vocal difficulties as well as substantial breathing and swallowing difficulties.
The following are some signs and symptoms of vocal cord paralysis:
- The voice has a breathy tone to it.
- Hoarseness
- Loud breathing
- Lack of ability to talk loudly
- Loss of gag reflex
- Coughing that is ineffective
- Vocal pitch loss
- Choking or coughing while eating, drinking, or swallowing saliva
- The requirement to take several deep breaths when speaking
- Frequent throat clearing
WHAT ARE THE CAUSES OF VOCAL CORD PARALYSIS?
The nerve impulses to your voice box (larynx) are interrupted in vocal cord paralysis, resulting in muscular paralysis. Doctors frequently do not know what causes vocal cord paralysis. Among the known causes are:
- Surgical injury to the vocal cord: Damage to the nerves that serve your voice box may arise from surgery on or around your neck or upper chest. Thyroid or parathyroid gland surgery, esophageal, neck, and chest surgery are all risky procedures.
- Injuries to the neck or chest: Trauma to your neck or chest may cause damage to the nerves that serve your vocal cords or the voice box itself.
- Stroke: A stroke disrupts blood flow in the brain and may harm the area of the brain that sends messages to the voice box.
- Tumors: Tumors, both malignant and noncancerous, can develop in or around the muscles, cartilage, or nerves that govern the function of your voice box, causing vocal cord paralysis.
- Infections: Infections including Lyme disease, Epstein-Barr virus, and herpes can cause inflammation and damage to the nerves in the larynx.
- Neurological disorders: You may develop vocal cord paralysis if you have certain neurological diseases, such as multiple sclerosis or Parkinson's disease.
WHAT ARE THE RISK FACTORS FOR VOCAL CORD PARALYSIS?
The following factors may increase your chances of having vocal cord paralysis:
Having throat or chest surgery: People who require thyroid, throat, or upper chest surgery are at a higher risk of vocal cord nerve injury. Breathing tubes used in surgery or to assist you breathe if you have major respiratory problems can sometimes harm the vocal cord nerves.
Having a neurological disorder: Certain neurological diseases, such as Parkinson's disease or multiple sclerosis, increase the risk of developing vocal cord weakening or paralysis.
WHAT ARE THE COMPLICATIONS OF VOCAL CORD PARALYSIS?
Breathing problems caused by vocal cord paralysis might be modest, resulting in a harsh voice, or they can be severe, jeopardizing your life.
Because vocal cord paralysis prevents the airway from entirely opening or shutting, other issues may occur, such as choking or actually inhaling (aspirating) food or liquid. Aspiration that results in severe pneumonia is uncommon but serious, necessitating rapid medical attention.
HOW IS VOCAL CORD DIAGNOSED?
Your doctor will inquire about your symptoms and lifestyle, as well as listen to your voice and inquire about the length of time you've had vocal problems. The following tests may be conducted to better analyze your voice problems:
- Laryngoscopy: A mirror or a tiny, flexible tube (known as a laryngoscope or endoscope) or both will be used by your doctor to examine your voice cords. A videostrobolaryngoscopy test may also be performed using a specific scope with a tiny camera at its tip or a larger camera linked to the scope's viewing piece.
These specialized high-magnification endoscopes allow your doctor to examine your vocal cords directly or through a video monitor to assess the movement and position of the vocal cords, as well as if one or both vocal cords are impacted.
- Laryngeal electromyography: This test monitors the electric currents in the muscles of your voice box. To collect these measures, your doctor will often inject small needles through the skin of your neck into your vocal cord muscles.
This test normally does not reveal information that changes the course of therapy, but it may provide your doctor with information about how well you may recover. When performed between six weeks and six months after the onset of your symptoms, this test is most beneficial in predicting how you will recover.
- Blood tests and scans: Because a number of disorders can cause nerve damage, additional testing may be required to determine the source of the paralysis. Blood tests, X-rays, MRIs, and CT scans are all possible.
WHAT ARE THE TREATMENTS FOR VOCAL CORD PARALYSIS?
Treatment for vocal cord paralysis is determined on the origin, degree of symptoms, and time since onset of symptoms. Voice therapy, bulk injections, surgery, or a combination of treatments may be used in treatment.
In some cases, you may be able to recover without undergoing surgery. As a result, your doctor may recommend delaying permanent surgery for at least a year after the onset of your vocal cord paralysis.
However, surgical therapy with collagen-like compounds in bulk injections is frequently performed within the first three months following voice loss.
During the time you are waiting for surgery, your doctor may recommend voice therapy to keep you from using your voice incorrectly while the nerves recover.
Voice therapy
Voice therapy sessions consist of exercises or other activities designed to strengthen your vocal cords, enhance breath control during speech, prevent aberrant tension in other muscles surrounding the paralyzed vocal cord or cords, and protect your airway while swallowing. If your vocal chords were paralyzed at a spot that does not require extra mass or repositioning, voice therapy may be the only treatment you require.
Surgery
If your vocal cord paralysis symptoms do not improve on their own, surgical therapies to enhance your ability to talk and swallow may be recommended.
Surgical alternatives include:
Bulk injection: If the nerve to your vocal cord is severed, the vocal cord muscle will most likely be small and feeble. A specialist who specializes in laryngologic diseases (laryngologist) may inject your paralyzed vocal cord with a substance such as body fat, collagen, or another authorized filler substance to enhance bulk. This extra mass pushes the damaged vocal cord closer to the center of your voice box, allowing the opposing functioning and moving vocal chord to make closer touch with the paralyzed cord when you talk, swallow, or cough.
Structural implants: This treatment, also known as thyroplasty, medialization laryngoplasty, or laryngeal framework surgery, uses an implant in the larynx to realign the voice cord rather than a bulk injection. People who have this surgery may require a second surgery to relocate the implant in rare cases.
Vocal cord repositioning: A surgeon will slide a window of your own tissue from the outside of your voice box inward, forcing the paralyzed vocal cord toward the center of your voice box. This allows your unaffected vocal chord to vibrate more effectively against its paralyzed counterpart.
Replacement of the damaged nerve (reinnervation): In this procedure, a healthy nerve from another part of the neck is relocated to replace the injured vocal chord. It may take six to nine months for the voice to improve. Some doctors combine this procedure with a large injection.
Tracheotomy: Your airflow will be reduced if both of your vocal cords are paralyzed and near together. You will have difficulty breathing in this condition and will require a tracheotomy medical operation.
A tracheotomy involves making an incision at the front of your neck and creating an aperture directly into your windpipe (trachea). A breathing tube is placed to allow air to bypass the paralyzed vocal cords.
Treatments in development
Connecting the voice cords to another source of electrical stimulation — perhaps a nerve from another area of the body or a device akin to a cardiac pacemaker — may restore vocal chord opening and shutting. Researchers are still looking into this and other solutions.