Vocal Cord Paralysis

Vocal cords, also called vocal folds, play an important role in how we produce sounds. First there must be air in your lungs, which occurs through the act of inhaling. The air is then pushed through the lungs into your windpipe.

At the top of the windpipe sit your vocal cords, which stay open when breathing and close when you produce sound. As the air gets pushed out of the windpipe, it passes between the vocal cords, causing them to vibrate. This vibration sounds like buzzing. This sound is passed through the throat, nose and mouth, which all work together to change the buzzing into speech.

Symptoms of Vocal Cord Paralysis

Vocal cord paralysis is a movement disorder; this means that the movement of one or both of your vocal cords is weak or completely lost. When movement of one or both of the vocal folds is damaged, symptoms may include:

• Hoarseness
• Running out of air when you are talking
• Shortness of breath with activity
• Loud breathing sounds
• Swallowing problems, including coughing or choking when you eat and drink
• Frequent throat clearing
• Chronic cough
• Sleep and snoring problems

What causes vocal cord paralysis?

A movement problem with the vocal cords can be due to a number of illnesses and conditions, including:

• A viral illness (a cold, flu, bronchitis)
• Stroke
• Lyme’s disease
• Car and other accidents with direct trauma to the neck and voice box
• Tumors of the brain, neck or chest
• Procedures and surgery of the brain, neck or chest
• Intubation (breathing tube used in an emergency setting, during surgery, or in the ICU)

Occasionally, a cause is not identifiable.  The good news is that many of these vocal cord conditions are treatable.

Diagnosis & Treatment

Vocal fold movement disorders is a very diverse group of problems and may include weakness or complete paralysis of one or both vocal folds. An appropriate treatment plan begins with accurate diagnosis. Only a laryngologist (specialty trained voice physician and surgeon) can both accurately diagnose and effectively treat these conditions.

A thorough evaluation includes:

• A complete history
• A complete physical exam of the head and neck region
• Laryngoscopy and videostroboscopy (a specialized scope used to assess the function of the vocal cords)
• Imaging, when warranted
• Voice evaluation by a skilled therapist, specifically trained in the treatment of voice disorders

A treatment plan may include:

• Doing nothing, watchful waiting
• Targeted voice therapy
• Procedural and/or surgical solutions based on timing and nature of your voice and/or breathing symptoms

Thyroplasty

One such example of a procedure used to treat vocal fold paralysis is thyroplasty. This procedure is performed to help improve your voice, and at times, swallowing problems due to poor vocal fold function. One or both vocal folds may be weak or completely immobile. Patients with vocal fold weakness may have a weak, breathy voice and speaking may require considerable effort. If the vocal folds cannot close completely during swallowing, the patient may also experience coughing and choking while drinking and eating. The most common cause of vocal fold paralysis (complete) or paresis (partial weakness) is injury to the nerve that controls vocal fold movement. Other causes may include fixation, subluxation or dislocation of the joints that aid in vocal fold movement. Vocal fold movement problems may occur as a results of trauma, surgery, viral infection, stroke or other causes.

Procedure

This is an operation performed through a small incision in the skin near the voice box. A small portion of the voice box cartilage is removed and an implant is fashioned and secured into the cartilage. This implant acts as a shim that pushes the vocal fold to midline to improve vocal fold closure. A thyroplasty is usually performed under local anesthesia with sedation. This anesthesia technique allows the surgeon to fine-tune the patient’s voice by making minor modifications in the thyroplasty implant while the patient speaks back to the surgeon. After the vocal fold implant is placed, the surgeon may also check its position using a fiberoptic scope is inserted through the patient’s nose. In some cases, an implant is required in the opposite vocal fold to help strengthen the good side as well. The procedure requires one to two hours to complete. After the procedure, the patient is taken to the recovery room for observation and then admitted overnight to observe the airway. The patient is discharged from the hospital the following day.

After thyroplasty surgery

• You will be asked to rest your voice and this means no speaking for three to five days. This includes no talking, whispering or laughing. Measures may be taken to avoid cough as well.
• You are encouraged to get out of bed and take short walks with assistance, although strenuous activity, bending over and lifting greater than 15 pounds should be limited for the first two weeks after surgery.
• At the time of your post-operative appointment, you will meet with a voice therapist, if you have not already done so. You will be counseled on how to return to using your voice normally.
• At the time of discharge from the hospital, you will be instructed on how to take or modify your home medications. You may be prescribed a medicine for pain. Side effects may include drowsiness, constipation, nausea or vomiting. Measures will be advised on how to control these side effects.
• Incision care and wound monitoring will be reviewed by your surgeon and the nursing team before discharge from the hospital.

Want to learn more? Call DeFatta ENT & Allergy at (715) 828-2368 for more information or to schedule an appointment with our expert voice surgeon.