Vocal Cord Paralysis

This information describes the symptoms, diagnosis, and treatment of vocal cord paralysis (when your vocal cords aren’t able to move or work.

About Your Vocal Cords

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

Figure 2.
         
Figure 1.

When you breathe, your vocal cords open for 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.

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Vocal Cord Paralysis

Figure 3.

One or both of your vocal cords can become paralyzed (see Figure 3). The most common cause is an injury to the nerve that controls the movement of the muscles in the larynx (voice box). This injury may be caused by:

  • Surgery
  • A tumor in the neck, esophagus (food pipe), or lung
  • A brain injury due to a different causes, such as a stroke or a tumor

Sometimes, we don’t know what caused the vocal cord paralysis.

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Symptoms of Vocal Cord Paralysis

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. This is because liquids and food can go down your trachea instead of your esophagus. Another term for this is when foods “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 mucus after trying.
  • Shortness of breath during exercise.
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Diagnosing Vocal Cord Paralysis

You may have an endoscopy so that your doctor can look at your vocal cords to see if they’re moving or if they’re paralyzed. During your endoscopy, your doctor will use a flexible tube with a camera at the end called an endoscope. They will insert the endoscope into 1 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 have imaging tests done. These may include magnetic resonance imaging (MRI), a computed tomography (CT) scan, or a positron emission tomography (PET) scan. These tests are done to find out what has caused the paralysis.

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Treating Vocal Cord Paralysis

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 vocal cord that is paralyzed. This 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 some of the treatments described below.

Voice therapy

Voice therapy uses exercises to strengthen your vocal cords. It teaches you how to 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.

Then, your doctor will give you the injection. During the injection, you may feel mild discomfort. You will be asked not to speak, swallow, or cough during the injection. It helps if you breathe slowly and try to relax.

You may notice an improvement in your voice while the procedure is being done. Your voice may also sound strained, but it will improve once the materials in the injection spread throughout the vocal 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 injection

  • 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 people who don’t improve with other treatments. This type of surgery is called a laryngoplasty. 

In a laryngoplasty, your paralyzed vocal cord will be moved closer to your moving vocal cord while you’re 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. They will insert a piece of silicone material to let your moving vocal cord come into contact with your paralyzed one. Together, your vocal cords 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 (breathing) problems. You may get antibiotics to help lower the risk of infection. If you have swelling, you’ll be given steroids, which are medications that may help to reduce the swelling. Your doctor and nurse will give you more details, if needed.

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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
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