Vocal Cord Paralysis

What Is Vocal Cord Paralysis?

Vocal cord paralysis is a type of muscle tension disorder that occurs when the vocal cords are weak or paralyzed. Paralysis can be temporary or permanent, meaning that it will not heal on its own.

Causes of Vocal Cord Paralysis

Vocal cord paralysis can be caused by a virus or inflammatory disease, thyroid cancer or other tumors, or it can be a side effect of a neurologic disease.

Sometimes, the vagus nerve — which sends signals to the muscles controlling the vocal cords — is damaged during surgery for another condition, such as cancer, disc fusion, or carotid endarterectomy. This can cause the vocal cords to be paralyzed on one side (unilateral) or both sides (bilateral).

Vocal Cord Paralysis Symptoms

In unilateral vocal cord paralysis, the individual does not have the normal protection provided by the vocal cords on one side. As a result, food and liquid can pass into the airway, putting you at considerable risk of aspiration pneumonia. Unilateral vocal cord paralysis greatly affects quality of life and is particularly troublesome for professional voice users.

Symptoms of unilateral vocal cord paralysis include:

• Noticeable vocal fatigue
• Loss of projection
• Difficulty talking with background noise
• Limited pitch
• Lack of vocal endurance
• Micro-aspiration (minor intake of saliva and fluids) during the day

Bilateral vocal cord paralysis is rare and can put the individual at risk of suffocation. This is because the vocal cords, which are close together, can block airflow into the trachea and lungs.

Symptoms of bilateral vocal cord paralysis include:

• Changes in the voice (hoarseness or a breathy voice)
• Difficulty Breating
• Swallowing problems
• Changes in voice quality

Diagnosing Vocal Cord Paralysis

Voice and speech disorder specialists at the Penn Center for Voice, Speech and Swallowing will use your medical history, as well as other diagnostic tests, to assess vocal cord function for paralysis. These tests include:

• Blood tests
• CT Scan
• Electromyogram (EMG) – uses a very fine needle known as an electrode that is inserted into the muscle to record muscle and nerve activity.
• Laryngoscope – uses a long, thin instrument with a light and a lens or small video camera on the end to view the larynx. This is inserted through the nose or mouth.
• Magnetic Resonance Imaging

Treating Vocal Cord Paralysis

The Penn Center for Voice, Speech and Swallowing offers the latest treatments available for vocal cord paralysis. If it is deemed that your vocal cord paralysis is permanent, then surgery is needed to correct it or alleviate your symptoms. A coordination of surgical intervention and speech therapy provides patients with the best chance for voice preservation and restoration and a return to normal activities.

Treatment for Unilateral Vocal Cord Paralysis

• Medialization thyroplasty is a surgical treatment for people with permanent unilateral vocal cord paralysis. During this procedure, the paralyzed vocal cord is medialized, or moved toward the midline of the body, using a permanent implant that is positioned to achieve the desired vocal quality and function. Implants can be made from safe, synthetic materials such as gore-tex, silastic or calcium hydroxide.
• Medialization thyroplasty with autograft is an advanced approach that was pioneered by Penn Medicine for people with permanent unilateral vocal cord paralysis. This procedure uses the patient’s own tissue (autograft), often from the thigh rather than a synthetic material. In addition to achieving the desired vocal quality and function, this approach reduces the risk of implant rejection or wound breakdown. Patients often return home the day after surgery.

• Augmentation is the first line of treatment for people with temporary unilateral paralysis. An FDA-approved synthetic material is injected into the paralyzed vocal cord. This holds the vocal cord in the desired position to provide optimal function and reduce risk of aspiration pneumonia while it heals. This is a temporary remedy, however, and the injectable needs to be reabsorbed within three to six months.

  In instances where temporary unilateral paralysis is a result of tumor resection during cancer treatment, augmentation is performed soon after surgery and allows for a quicker return to normal life for close to 85% of people with voice complaints.

  Augmentation at the Penn Center for Voice, Speech and Swallowing is often accompanied by speech therapy to improve breathing techniques and optimize quality of life while you heal.

Treatment for Bilateral Vocal Cord Paralysis

• Partial endoscopic cordectomy is a minimally invasive procedure for patients with bilateral vocal cord paralysis who require tracheostomy. A tracheostomy is a procedure in which an incision is placed in the trachea to provide an alternative airway. During partial endoscopic cordectomy, a small portion of the posterior vocal cord is cut away to create an opening sufficient to result in a functional voice, yet not so large that it results in increased aspiration risk. This is a highly precise approach that is associated with significant improvement in breathing.
• Occasionally patients with bilateral vocal cord paralysis require a more advanced open surgical technique such as medialization thyroplasty or augmentation.

 

Penn Programs & Services for Vocal Cord Paralysis