Vocal cord paralysis

Vocal cord paralysis occurs when the nerve impulses to your voice box (larynx) are interrupted. This results in paralysis of the muscle of the vocal cords. Vocal cord paralysis can affect your ability to speak and even breathe. That's because your vocal cords, sometimes called vocal folds, do more than just produce sound. They also protect your airway by preventing food, drink and even your saliva from entering your windpipe (trachea) and causing you to choke. There are a number of causes of vocal cord paralysis including damage to nerves during surgery and certain cancers. Vocal cord paralysis can also be caused by a viral infection or a neurological disorder.

Symptoms
Your vocal cords are two flexible bands of muscle tissue that sit at the entrance to the windpipe (trachea). When you speak, the bands come together and vibrate to make sound. The rest of the time, the vocal cords are relaxed in an open position, so you can breathe. In most cases of vocal cord paralysis, only one vocal cord is paralyzed. If both of your vocal cords are affected, you may have vocal difficulties, as well as significant problems with breathing and swallowing. Signs and symptoms of vocal cord paralysis may include:

A breathy quality to the voice Hoarseness Noisy breathing Loss of vocal pitch Choking or coughing while swallowing food, drink or saliva The need to take frequent breaths while speaking Inability to speak loudly Loss of your gag reflex Ineffective coughing Frequent throat clearing

Causes

In vocal cord paralysis, the nerve impulses to your voice box (larynx) are disrupted, resulting in paralysis of the muscle. Doctors often don't know the cause of vocal cord paralysis. Known causes may include:

Injury to the vocal cord during surgery. Surgery on or near your neck or upper chest can result in damage to the nerves that serve your voice box. Surgeries that carry a risk of damage include surgeries to the thyroid or parathyroid glands, esophagus, neck, and chest. Neck or chest injury. Trauma to your neck or chest may injure the nerves that serve your vocal cords or the voice box itself. Stroke. A stroke interrupts blood flow in your brain and may damage the part of your brain that sends messages to the voice box. Tumors. Tumors, both cancerous and noncancerous, can grow in or around the muscles, cartilages or nerves of your voice box and can cause vocal cord paralysis. Inflammation. Arthritis or surgery can cause inflammation and scarring of the vocal cord joints or the space between the two vocal cord cartilages, and this inflammation may prevent your vocal cords from opening and closing. The symptoms and signs of this disorder mimic vocal cord paralysis, even though the vocal cord nerves remain normal. In addition, some viral infections can cause inflammation and damage directly to the nerves in the larynx. Neurological conditions. If you have certain neurological conditions, such as multiple sclerosis or Parkinson's disease, you may experience vocal cord paralysis.

Risk factors
Factors that may increase your risk of developing vocal cord paralysis include:

Being female. Women are slightly more likely to develop vocal cord paralysis. Undergoing throat or chest surgery. People who need surgery on their thyroid, throat or upper chest have an increased risk of vocal cord nerve damage. Sometimes breathing tubes used in surgery or to help you breathe if you're having serious respiratory trouble can damage the vocal cord nerves.

Having a neurological condition. People with certain neurological conditions such as Parkinson's disease, multiple sclerosis or myasthenia gravis are more likely to develop vocal cord weakness or paralysis.

Complications
Breathing problems associated with vocal cord paralysis may be so mild that you just have a hoarse-sounding voice, or they can be so serious that they're life-threatening. Because vocal cord paralysis keeps the opening to the airway from completely opening or closing, other complications may include choking on or actually inhaling (aspirating) food or liquid. Aspiration that leads to severe pneumonia is very serious and requires immediate medical care.

Tests and diagnosis

Endoscopy. Doctor will look at the vocal cords using a mirror or a thin, flexible tube (endoscope) or both. A test called videostrobolaryngoscopy that's done using a special scope that contains a tiny camera at its tip or a larger camera connected to the scope's viewing piece. These special endoscopes allow to view the vocal cords directly or on a video monitor to determine the movement and position of the vocal cords and whether one or both vocal cords are affected.

Laryngeal electromyography. This test measures the electric currents in your voice box muscles. To obtain these measurements, the doctor typically inserts small needles into the vocal cord muscles through the skin of the neck. This test is only rarely performed because it doesn't usually provide information that might change the course of treatment. Blood tests and scans. Because a number of diseases may cause a nerve to be injured, additional tests to identify the cause of the paralysis. Tests may include blood work, lung function tests, X-rays, MRI or CT scans. Voice therapy Voice therapy sessions involve exercises or other activities to strengthen your vocal cords, improve breath control during speech, prevent abnormal tensions in other muscles around the paralyzed vocal cord and protect your airway during swallowing. Occasionally, voice therapy may be the only treatment you need if your vocal cords were paralyzed in a location that doesn't require additional bulk or repositioning.

Coping and support

Vocal cord paralysis can be frustrating and sometimes debilitating, especially because your voice affects your ability to communicate. A speech therapist can help you develop the skills you need to communicate. Even if you're not able to regain the voice you once had, speech therapy can help you learn effective ways to compensate. In addition, a speechlanguage pathologist can teach you efficient ways to use your voice without causing further damage to the vocal mechanism.