This information describes the symptoms, diagnosis, and treatment of vocal cord paralysis.

Your vocal cords are 2 elastic bands of tissue in your larynx (voice box). They form the entry into your trachea (windpipe). Your doctor can see them with a mirror held in the back of your throat (see Figure 1).

When you breathe, your vocal cords open to allow the passage of air (see Figure 2). When you laugh, cough, or speak, your vocal cords come together and vibrate. Your vocal cords are also important for swallowing. They prevent food from going into your lungs by closing tightly when you swallow.

One or both of your vocal cords can become paralyzed (see Figure 3), or not able to work. The most common cause is an injury to the nerve that controls the movement of the muscles in the larynx. This injury may be caused by:

  • Surgery
  • A tumor in the neck, esophagus (food pipe), or lung
  • An injury to the brain due to a variety of causes, including a stroke or a tumor

Sometimes, the cause is not known.

Symptoms

Vocal cord paralysis may cause any or all of the following symptoms:

  • Voice that is hoarse, weak, or lost completely
  • Problems swallowing
    • Including choking, coughing, or both because liquids and food “go down the wrong pipe”
    • In severe cases, choking can lead to shortness of breath or pneumonia
  • Weak cough, including not being able to cough up mucous after trying
  • Shortness of breath during exercise

Diagnosis

To make a diagnosis, your doctor will look at your vocal cords with an endoscope. This is a tube with a camera at the end that is inserted through one of your nostrils and into your throat. Your doctor will look at your vocal cords as you speak some words. If the cause of the paralysis is not known, your doctor may recommend that you get magnetic resonance imaging (MRI), a computed tomography (CT) scan, or a positron emission tomography (PET) scan. This procedure is done to find out what has caused the paralysis.

Treatment

For some patients, the paralyzed vocal cord may recover and the voice may return without any treatment. In some cases, the uninjured vocal cord may take over for the paralyzed vocal cord. This type of improvement usually happens within the first year or so after damage to the vocal cord. In other cases, the vocal cord is permanently paralyzed.

If you have problems with swallowing or your voice is hoarse, you may need treatment. Your doctor may recommend any of the treatments described below.

Voice therapy

Voice therapy uses exercises to strengthen your vocal cords. It teaches you how to make up for your paralyzed vocal cord.

Injections

Injections into your paralyzed vocal cord may improve your voice and swallowing problems. They may help for a few months until your vocal cord recovers.

A vocal cord injection is made up of material that adds bulk to your paralyzed cord. This moves your paralyzed cord closer to your uninjured cord.

The injection can be done with a local anesthetic (medication that numbs an area of your body) in your doctor's office. You will make sounds while the doctor listens to the quality of your voice and looks at your vocal cords using an endoscope. During the injection, you may feel mild discomfort.

You may notice an improvement in your voice while the procedure is being done. However, the final result can take weeks. Until then, your voice quality will vary from day to day.

After the injection, you will need to be monitored in the clinic for about  30 minutes to make sure you have no problems.

After your procedure:

  • Do not eat or drink anything for 2 hours. You will need this time for your anesthesia to wear off.
  • Avoid screaming and whispering, which can irritate your vocal cords.

Surgery

Surgery to move your paralyzed vocal cord is another option. It may be helpful for patients who don't improve with other treatments.

If you have surgery, your paralyzed vocal cord will be moved closer to your uninjured vocal cord while you are under anesthesia (medication that makes you sleep during surgery). Your surgeon will make an incision on your neck, on the side of your paralyzed vocal cord. He or she will then insert a piece of material to center your paralyzed vocal cord. This lets your uninjured vocal cord come into contact with your paralyzed one. Together, they will make your voice work and protect your breathing passage when you swallow.

You will stay in the hospital overnight after your surgery. There is a small risk of infection and swelling, which can lead to respiratory problems. You may get antibiotics to help lower the risk of infection. If you have swelling, you will be given steroids. Your doctor and nurse will give you more details, if needed.

Call Your Doctor Immediately if You Have:

  • A temperature of 100.4° F (38.0° C) or higher
  • Trouble breathing
  • Shortness of breath
  • Noisy breathing
  • More problems with swallowing