vocal cord paralysis

Introduction

Paralysis of one or both of the vocal cords (or vocal folds).

Etiology

• head trauma
• stroke
• Parkinson's disease
• multiple sclerosis
• neck injury
• malignancy
  • lung cancer
  • thyroid cancer
  • tumor pressing on recurrent laryngeal nerve
• viral infection
• idiopathic

Epidemiology

• common, especially in elderly (see etiology)

Pathology

• aspiration common
• dyspnea if both cords affected (rare) (air passage to the trachea blocked)

Clinical manifestations

• symptoms can range from mild to life threatening
• dysphagia
• cough
• voice changes, changes in voice quality
  • discomfort from vocal straining
• if only one vocal cord is damaged
  • voice is usually hoarse or breathy
  • changes in voice quality, loss of volume or pitch
• damage to both vocal cords (rare) generally causes dyspnea

Diagnostic procedures

• endoscopy
• acoustic spectrography by speech pathology
• laryngeal electromyography (NGC)

Management

• surgery
  • often delayed (1 year) to see if spontaneous resolution will occur
  • involves adding bulk to the paralyzed vocal cord or changing its position
    • bulking agents injected into paralyzed vocal cord
      • Teflon, collagen, silicone, or body fat used
      • added bulk reduces the space between the vocal cords so the nonparalyzed cord can make closer contact with the paralyzed cord & thus improve the voice
    • permanently shifting a paralyzed cord closer to the center of the airway may improve the voice
      • allows the nonparalyzed cord to make better contact with the paralyzed cord
  • can improve both voice & swallowing
  • tracheostomy if both vocal cords paralyzed
• voice therapy (speech pathology)

Prognosis:

• in some cases, the voice returns without treatment during the first year after damage

More general terms

• vocal cord dysfunction; inducible laryngeal obstruction

Additional terms

• vocal cord/fold/shelf (Ferrein cords, true vocal cord)