"I can come by here and have a couple of polyps lasered off my vocal cords and then go straight to work."
— Daryl Collins, age 53

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Vocal Cord Paralysis

Anatomy of the Condition:

The vocal cords, or vocal folds are located within the larynx or voice box. They are structures which open for breathing, come together during swallowing, and vibrate as air passes between them during speaking or singing. They are made up of fine layers with a soft outer cover, a stiffer ligament below this, and a muscle called the thyroarytenoid muscle located deep to the ligament. The thyroarytenoid muscle makes up the bulk of the vocal fold.

Paralysis of the vocal cords causes an inability to move the muscles of the vocal cords and can impact all three functions of the larynx. When one vocal fold is paralyzed (unilateral vocal cord paralysis), voice and sometimes swallowing are impaired. When both vocal folds are paralyzed (bilateral vocal cord paralysis), the airway and breathing are severely compromised.

Causes or Contributing Factors:

Vocal fold paralysis can be caused by surgical injury, trauma, tumors or viral infections.

Symptoms of Unilateral Cord Paralysis:

  • A soft, breathy voice
  • Difficulty with vocal projection
  • Impairment of the ability to swallow, with aspiration into the air passage or lungs. Rarely, this can lead to pneumonia.

Symptoms of Bilateral Cord Paralysis:

  • Difficulty breathing from airway obstruction
  • Stridor, a condition that closes the airway when breathing and causes noises in the throat and changes in the shape of the chest as the body struggles to breathe.


The physician will ask the patient about symptoms and medical history, followed by a thorough head and neck examination. The examination likely will involve several members of The Emory Voice Center team to test for vocal quality, efficiency, and proper speaking technique. Laryngeal videostroboscopy may be required. This is a procedure using a flexible and/or rigid endoscope coupled to a video monitor and a stroboscopic light source to allow for detailed visual evaluation of laryngeal function and vibration.

Microlaryngoscopy may be required. It is a procedure conducted under general anesthesia which allows the physician to examine the vocal folds of the larynx with magnification tools.

Other tests to confirm diagnosis can include a CT scan or MRI, which provide high-resolution images of the structures of the neck and larynx.

Treatment for Unilateral Vocal Cord Paralysis:

After vocal cord paralysis occurs, it can take up to a year for movement to return. During this time, speaking and swallowing therapy can be helpful to improve voice and swallowing function while waiting for vocal fold motion to return.

Sometimes vocal cord movement does not return, and patients may need to undergo surgery to improve their voice and swallowing. Surgical options include thyroplasty, injection laryngoplasty, or laryngeal reinnervation. Thyroplasty and injection laryngoplasty attempt to move the paralyzed vocal fold toward the mobile vocal fold to improve voice and swallowing. Laryngeal reinnervation is a surgical procedure to restore nerve supply to the paralyzed vocal fold in order to improve its tone and bulk.

Treatment for Bilateral Vocal Cord Paralysis:

Because of airway obstruction, bilateral vocal cord paralysis is a more serious problem than unilateral vocal cord paralysis. Often a lifesaving tracheotomy is required to provide a breathing passage.

After a safe airway is created, there are several surgical procedures which attempt to improve the airway while minimizing effect on the voice. These include posterior vocal cordotomy and endoscopic laser arytenoidectomy. Posterior vocal cordotomy is an endoscopic procedure in which one or both of the vocal folds are divided to improve the airway. Another minimally invasive surgical option is endoscopic laser arytenoidectomy. With this procedure, a laser is used to remove one of the cartilages which makes up the vocal fold to widen the air passage and improve breathing. Some patients benefit from laryngeal Botox therapy.