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

Vocal Cords

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 air to pass (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.

Vocal Cord Paralysis

One or both of your vocal cords can become paralyzed (see Figure 3), or not able to move or 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
  • A brain injury due to a variety of causes, including a stroke or a tumor

Sometimes, the cause of vocal cord paralysis 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

You may have an endoscopy so that your doctor can look at your vocal cords to see if they are moving or paralyzed. During your endoscopy, your doctor will use a flexible tube with a camera at the end called an endoscope. He or she will insert the endoscope into one of your nostrils and into your throat. Your doctor will look at your vocal cords as you speak some words.

Your doctor may also recommend that you get imaging procedures. These may include magnetic resonance imaging (MRI), a computed tomography (CT) scan, or a positron emission tomography (PET) scan. These procedures are done to find out what has caused the paralysis.

Treatment

In some people, the paralyzed vocal cord may recover and the voice may return without any treatment. In other cases, the uninjured, moving vocal cord may take over for the paralyzed vocal cord. This type of improvement usually happens within the first year. Sometimes, the vocal cord is permanently paralyzed.

You may need treatment if you have problems with swallowing or your voice is hoarse. 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 use your moving vocal cord to make up for your paralyzed vocal cord.

Injection

You may have an injection (shot) into your paralyzed vocal cord to improve your voice and swallowing problems. The material in the injection makes your vocal cord more bulky which moves your paralyzed cord closer to your moving cord. The injection may help for a few months until your vocal cord recovers.

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 your 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 will be asked not to speak or swallow or cough during the injection. It helps if you breathe easy and try to relax.

You may notice an improvement in your voice while the procedure is being done. Your voice may also sound strained; it will improve once the materials in the injection distribute throughout the cord. This can take days to 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 moving vocal cord while you are under general anesthesia (medication that makes you sleepy). Your surgeon will make an incision (surgical cut) on your neck, on the side of your paralyzed vocal cord. He or she will then insert a piece of material to let your moving 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 or Nurse 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