Vocal cord paralysis

Vocal cords must close tightly to produce sound and keep food out of the lungs. Paralysis prevents this essential closure.

What is Vocal Cord Paralysis?
Vocal cord paralysis occurs when the nerve impulses to your voice box (larynx) are interrupted, resulting in the inability of one or both of the vocal cords to move.



The Dual Function: Your vocal cords serve two critical biological purposes:

1. Speech: They vibrate together as air passes through to create sound.
2. Protection: They act as the primary valve that closes tightly when you swallow to prevent food, liquids, or saliva from entering your windpipe.

Symptoms

The signs of vocal cord paralysis depend on whether the cord is fixed in the "open" position, the "closed" position, or somewhere in between.

• Breathy, Whispering Voice: You may sound like you are constantly whispering because air is leaking through the gap between the cords.
• Persistent Hoarseness: A chronic raspy, strained, or "wet" sounding voice.
• Noisy Breathing (Stridor): A high-pitched sound during inhalation, typically occurring if the cords are paralyzed in a closed position.
• Ineffective Cough: The inability to create the pressure needed for a strong cough to clear your throat.
• Frequent Throat Clearing: Often necessary while eating or drinking.

When to See a Doctor

You should schedule an evaluation with an Otolaryngologist (ENT) if you experience unexplained hoarseness that lasts longer than two weeks. Seek emergency medical attention immediately if you experience sudden, significant difficulty breathing, or if you find yourself choking and coughing every time you attempt to swallow liquids.

One vs. Both Cords

Type	Severity	Main Clinical Issue
Unilateral (One cord paralyzed)	Most Common	Voice & Swallowing. The healthy cord must over-extend to try to meet the paralyzed one.
Bilateral (Both cords paralyzed)	Medical Emergency	Breathing. If both cords are paralyzed in the center, they block the airway. This often requires a Tracheotomy.

⚠️ DANGER: ASPIRATION RISK
When vocal cords cannot seal properly, food or liquid can "slip" into the lungs instead of the esophagus.

Signs to watch for: Choking or coughing every time you drink water. This can lead to Aspiration Pneumonia, a severe and potentially life-threatening lung infection.

Causes

Damage to the recurrent laryngeal nerve is the most common path to paralysis. Triggers include:

• Surgery (Most Common): Accidental trauma during Thyroid, neck, or chest surgery.
• Tumors: Benign or malignant growths (like lung or thyroid cancer) pressing against the nerves.
• Viral Infections: Inflammation from viruses (such as Epstein-Barr or Lyme disease) can lead to nerve damage.
• Neurological Conditions: Multiple sclerosis, Parkinson’s disease, or a stroke can disrupt the brain’s ability to control these muscles.

Diagnosis

To diagnose the condition, an ENT specialist will perform a physical exam and utilize specialized tools:

• Laryngoscopy: A thin, flexible tube with a camera is passed through the nose to the back of the throat to watch the cords in motion.
• Laryngeal Electromyography (LEMG): Measures the electrical currents in the muscles of the voice box to determine the level of nerve damage and the chances of recovery.

Treatment Options

In many cases, doctors recommend waiting 6 to 12 months before pursuing permanent surgery, as the nerves may partially or fully recover on their own.

1. Voice Therapy

A specialized speech-language pathologist provides exercises to strengthen the vocal folds, improve breath support, and teach the functioning cord to compensate for the paralyzed one.

2. Surgical Options

• Bulk Injection: A doctor injects a filler (like collagen, body fat, or synthetic paste) into the paralyzed cord. This "plumps" the cord so the healthy cord can reach it more easily to create a seal.
• Thyroplasty (Medialization): A permanent implant is placed in the larynx to physically push the paralyzed cord toward the center of the voice box.
• Tracheotomy: In severe bilateral cases, a surgical opening is made in the neck to provide a direct airway into the windpipe.

Lifestyle & Coping

• The "Chin Tuck": When swallowing, tuck your chin firmly toward your chest. This physical repositioning helps narrow the airway and reduces the risk of aspiration.
• Humidification: Use a humidifier to prevent the vocal fold tissues from drying out and becoming further irritated.
• Voice Conservation: Use personal voice amplifiers if you must speak for long periods to avoid straining the remaining healthy muscle.

Frequently Asked Questions (FAQs)

Can vocal cord paralysis be reversed?

It depends on the cause. If the nerve was only bruised or inflamed (from a virus or minor surgical trauma), it may recover fully within several months. However, if the nerve was severed or permanently damaged, the paralysis is usually permanent, though voice and swallowing can be significantly improved with treatment.

Will I ever be able to sing again?

Many patients can return to singing with extensive voice therapy and surgical medialization. While the vocal range and power may be different than before, modern treatments are highly effective at restoring a functional, clear voice.

References

• American Academy of Otolaryngology–Head and Neck Surgery
• Mayo Clinic - Vocal Cord Paralysis Overview
• National Institute on Deafness and Other Communication Disorders (NIDCD)