Vocal Cord (or Fold) Paralysis

Anatomy of the Condition

The vocal folds (or cords) are inside the larynx or voice box. These structures open for breathing. They come together during swallowing. They vibrate as air passes between them during speaking or singing. Fine layers with a soft outer cover make up the vocal folds. A stiffer ligament lies below the thyroarytenoid muscle connects deep to the ligament. The thyroarytenoid muscle makes up the bulk of the vocal fold.

Vocal fold paralysis is an inability to move the muscles of the vocal cords. This can impact all three functions of the larynx. Paralysis of one vocal fold (unilateral vocal fold paralysis) can impair voice and sometimes swallowing. Paralysis of both vocal folds (bilateral vocal fold paralysis) can compromise the airway and breathing.

Surgical injury, trauma, tumors or viral infections can cause vocal fold paralysis.

Symptoms of paralysis in one vocal cord can include:

• 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 paralysis of both vocal cords include:

• Difficulty breathing from airway obstruction
• Stridor, usually a high-pitched noise, may be heard when taking a deep breath in. The vocal folds cannot separate effectively enough to allow a normal passage of air and results in turbulent airflow and the high-pitched sound described above.

Our team will discuss your symptoms and medical history. We will perform a thorough head and neck examination. Our evaluation team often involves several members of the Emory Voice Center. We will assess vocal quality, efficiency, and proper speaking technique.

We may complete a laryngeal videostroboscopy. In this minimally invasive procedure, we use an endoscope (a small tube equipped with a fiber optic camera.) A stroboscopic light source lets us check laryngeal function and vibration.

We may recommend microlaryngoscopy. A physician will examine the vocal folds of the larynx with magnification tools. We conduct this procedure under general anesthesia.

We may perform A CT scan or MRI to confirm your diagnosis. These provide high-resolution images of the structures of the neck and larynx.

In cases of vocal cord paralysis, it can take up to a year for movement to return. During this time, speaking and swallowing therapy can help. They can both improve voice and swallowing function while waiting for vocal fold motion to return.

Sometimes vocal cord movement does not return. In this case, you may need to undergo surgery to improve your 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. This improves voice and swallowing. Laryngeal reinnervation restore nerves supply to the paralyzed vocal fold to improve its tone and bulk.

Airway obstruction makes bilateral vocal cord paralysis a more serious problem than unilateral vocal cord paralysis. A lifesaving tracheotomy may be required to provide a breathing passage.

After we create a safe airway, there are several surgical options. These procedures attempt to improve the airway while minimizing the effect on the voice. These include posterior vocal cordotomy and endoscopic laser arytenoidectomy. In posterior vocal cordotomy, (an endoscopic procedure), we divide one or both of the vocal folds to improve the airway. Endoscopic laser arytenoidectomy is another minimally invasive surgical option. We use a laser to remove one of the cartilages which makes up the vocal fold. This widens the air passage and improve breathing. Some patients also benefit from laryngeal Botox therapy.

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