Vocal Cord Paralysis

The vocal cords are two bands of muscle tissue in the voice box (larynx), directly above the windpipe. They stay apart when you breathe, close tightly when you swallow, and vibrate when you speak. The nerves that control them run through the neck and upper chest. When one of these nerves is injured, the vocal cord on that side may stop moving normally.

Paralysis of one vocal cord is common. Paralysis of both vocal cords is rare and can be life-threatening because it can narrow the airway.

Vocal cord paralysis can result from:

• Injury to the head, neck, or chest, including injury to the nerves that control the vocal cords
• Surgery in the neck or chest, such as thyroid surgery, where these nerves run close to the operating area
• Tumors of the skull base, neck, or chest, including lung and thyroid cancer
• Infections, such as Lyme disease
• Neurologic conditions, including multiple sclerosis, Parkinson’s disease, and stroke

In many cases, no cause is found.

• Hoarseness or a breathy voice
• Loss of volume or changes in pitch
• Shortness of breath or noisy breathing
• Choking or coughing when eating or drinking, because food or liquid enters the windpipe

Seek emergency care for difficulty breathing, noisy breathing at rest, or repeated choking.

Vocal cord paralysis is usually diagnosed by an otolaryngologist. The evaluation starts with your history: when the voice change began and any injury, surgery, or illness before it. Dr. Kayem listens to your voice and examines the vocal cords directly with a thin scope with a light at its tip, which shows how each cord moves. Depending on the findings, imaging of the head, neck, or chest may be ordered to look for the cause. A test of the electrical activity of the voice box nerves is sometimes used to understand the paralysis in more detail.

The most common treatments are voice therapy and surgery.

• Voice therapy with a speech-language pathologist uses exercises to strengthen the vocal cords and improve breath control while speaking.
• Waiting period. Some voices recover on their own during the first year after diagnosis, so surgery is often delayed during that time.
• Surgical procedures reposition the paralyzed vocal cord closer to the other one, for example with an implant or an injection, so the cords can meet when you speak and swallow.
• When both vocal cords are paralyzed, treatment focuses on keeping the airway open, and a breathing tube placed through the front of the neck (tracheotomy) may be needed.

Neck injuries can also affect other structures of the throat and neck. See Neck Trauma.