Vocal Cord Paralysis

Overview

Vocal cord paralysis is a condition in which the muscles controlling the voice box (larynx) lose their ability to control movement. This results from disrupted nerve impulses to the voice box. Vocal cord paralysis can cause difficulty in speaking and, in some cases, breathing. It can arise from nerve damage during surgery, viral infections, or certain cancers. Symptoms may include a breathy voice, hoarseness, noisy breathing, shortness of breath, loss of pitch, choking during swallowing, and the need for frequent breaths while speaking. Complications can range from mild hoarseness to life-threatening breathing problems, such as choking on food or liquid. Risk factors for vocal cord paralysis may include undergoing throat or chest surgery, having a neurological condition, or being older in age.

Understanding the disease

Symptoms

Symptoms of vocal cord paralysis may include a breathy quality to the voice, hoarseness, noisy breathing, shortness of breath, 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 the gag reflex, ineffective coughing, and frequent throat clearing. These symptoms can range from mild to severe, and in some cases, they may affect breathing and swallowing.

Risk Factors

Risk factors for developing vocal cord paralysis include undergoing throat or chest surgery, having a neurological condition such as Parkinson's disease or multiple sclerosis, and experiencing a neck or chest injury. Other possible risk factors are stroke, tumors, infections such as Lyme disease, Epstein-Barr virus, and herpes, and complications arising from COVID-19 infection.

Development

Vocal cord paralysis can develop due to several reasons, including neck or chest injury, stroke, tumors, infections, and neurological conditions. When the nerve impulses to your voice box (larynx) are disrupted, the muscles controlling your voice become paralyzed, leading to various symptoms like a breathy quality to the voice, hoarseness, noisy breathing, shortness of breath, loss of vocal pitch, choking or coughing while swallowing, inability to speak loudly, and more. In most cases, only one vocal cord is paralyzed, but paralysis of both vocal cords can also occur, causing more significant problems with breathing and swallowing.

Assessment and Diagnosis

Triage

If you have unexplained hoarseness that lasts for more than 2 to 4 weeks, or if you notice any unexplained voice changes or discomfort, contact your health care provider. It's important to seek medical attention if you suspect vocal cord paralysis, as it can lead to breathing problems and other complications.

Diagnosis

To diagnose vocal cord paralysis, your healthcare provider will likely ask about your symptoms and lifestyle, listen to your voice, and inquire about how long you've had voice problems. They may also perform one or more of the following tests:

1. Laryngoscopy: Your healthcare provider will use a mirror, a thin, flexible tube (endoscope), or both to examine your vocal cords. In some cases, a special endoscope with a camera may be used (videostrobolaryngoscopy).
2. Laryngeal electromyography: This test measures the electrical currents in your voice box muscles. The healthcare provider will insert small needles into the vocal cord muscles through the skin of your neck.
3. Blood tests and scans: Additional tests may be necessary to identify the cause of the paralysis, including blood work, X-rays, MRI, or CT scans. These tests do not require any special preparation, but you should inform your healthcare provider about any medications or supplements you are taking that might affect the test results.

Management and Treatment

Complications

Complications of vocal cord paralysis can range from mild to severe. They may include:

1. Breathing problems: Vocal cord paralysis can cause difficulty in breathing, including shallow or rapid breathing.
2. Choking or aspiration: Since the vocal cords don't close properly, food or liquid may enter the airways, leading to choking or aspiration pneumonia.
3. Laryngeal or vocal cord cysts: Paralysis can result in the formation of cysts in the larynx, causing further complications.
4. Infections: Persistent hoarseness or difficulty in swallowing due to vocal cord paralysis may increase the risk of infections such as pneumonia or laryngitis.
5. Vocal cord fatigue: Overuse of the remaining functional vocal cord may lead to vocal cord fatigue, strain, or injury. It is essential to seek medical attention if you experience any signs or symptoms of vocal cord paralysis, as early diagnosis and treatment can help prevent or minimize potential complications.

Home Remedies

In most cases, vocal cord paralysis requires medical treatment, and home remedies may not be effective or appropriate. It is important to consult with a healthcare provider to discuss the best course of action for managing symptoms and treating vocal cord paralysis.

Treatment

Treatment options for vocal cord paralysis depend on the cause, severity of symptoms, and time since symptoms began. Treatment may include voice therapy, bulk injections, surgery, or a combination of treatments. In some cases, vocal cord paralysis may resolve on its own, so your healthcare provider may delay surgery for at least a year from the onset of symptoms. During this waiting period, voice therapy may be recommended to help you manage your symptoms and prevent improper use of your voice while the nerves heal. Bulk injection is a surgical option that involves adding bulk to a paralyzed vocal cord using substances such as body fat, collagen, or other approved filler substances. This procedure brings the affected vocal cord closer to the middle of the voice box, enabling better contact with the opposing vocal cord during speech, swallowing, or coughing. Other treatments may include blood tests and scans to identify the underlying cause of paralysis, and laryngeal electromyography to measure the electrical currents in the voice box muscles. However, this test is not used to guide treatment but may provide information about recovery prospects. Please consult with a healthcare provider or laryngologist for personalized advice and the most up-to-date information on treating vocal cord paralysis.

Preparing for medical consultation

To prepare for an appointment for vocal cord paralysis, you should:

1. Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for the appointment.
2. Note key personal information, such as any major stresses, recent illnesses, or life changes.
3. Create a list of all medications, vitamins, or supplements you're taking, including the dose of each.
4. If possible, ask a family member or friend to accompany you to the appointment. This can help you remember important information discussed during the appointment.
5. Prepare a list of questions to ask your healthcare provider. Some questions to consider include:
   • What is the most likely cause of my vocal cord paralysis?
   • What kinds of tests do I need? Do these tests require any special preparation?
   • Is this condition temporary, or will my vocal cords always be paralyzed?
   • What treatments are available, and which do you recommend?
   • What types of side effects can I expect from treatment?
   • Are there any alternatives to the recommended treatment?
   • Are there any restrictions on using my voice after treatment? If so, for how long?
   • Will I be able to talk or sing after treatment?
   • Are there any brochures or other printed material that I can take home with me?
6. Expect your healthcare provider to ask about the onset of your symptoms, any associated events or circumstances, and about your lifestyle and voice usage. Remember to be open and honest with your healthcare provider about your symptoms and concerns, and don't hesitate to ask any additional questions that come up during the appointment.