17624 Vocal Cord Paralysis

Overview

Your vocal cords are two flexible bands of muscle inside your voice box (larynx) that vibrate to make sound. Vocal cord paralysis happens when the nerves that control these bands are damaged, so the cords cannot open and close properly. This can affect your voice, your breathing, and your ability to swallow.

It is not very common. About 20 people in every 100,000 are affected each year. It is a condition that doctors in general practice often refer to a specialist ear, nose, and throat (ENT) clinic.

It can affect anyone, but it is more common in adults. It can also affect children, usually after surgery on the chest or neck, or due to a birth defect. Older adults may be more likely to develop it as a result of stroke, cancer, or neck surgery.

Symptoms

Common symptoms

• Hoarse or breathy voice
• Weak voice that tires easily
• Noisy or difficult breathing
• Frequent throat clearing
• Choking or coughing when eating or drinking
• Coughing that does not go away
• Loss of vocal pitch range (trouble singing or shouting)

Symptoms in children

• Weak cry or hoarse cry
• Noisy breathing (stridor)
• Trouble feeding
• Poor weight gain

Symptoms in older adults

• Voice changes that get worse over time
• Shortness of breath during daily activities
• More noticeable difficulty swallowing

Causes

Main causes

• Damage to the recurrent laryngeal nerves that control the vocal cords (often from surgery on the neck, chest, or thyroid gland)
• Stroke
• Neck or chest injury
• Viral infections that affect the nerves (such as a cold or flu)
• Tumours or growths in the neck, chest, or lungs pressing on the nerve
• Neurological diseases such as Parkinson's disease or multiple sclerosis (sometimes)
• Sometimes the cause is unknown (idiopathic)

Risk factors

• Recent neck, chest, or heart surgery
• History of stroke or neurological disease
• Smoking (increases risk of laryngeal and lung cancer that can press on the nerve)
• Chronic alcohol use
• Occupational or recreational neck injuries

When to see a doctor

See a doctor urgently if:

• If you have new trouble breathing or noisy breathing
• If you have sudden voice loss with weakness or numbness
• If you are choking on food or saliva regularly
• If you have any symptoms of stroke

Book a routine appointment if:

• If your voice stays hoarse or weak for more than 3 weeks
• If it is hard to swallow without coughing or throat clearing
• If your voice problem affects your quality of life
• If you feel a lump in your neck

Diagnosis

A doctor will ask about your symptoms and look at your vocal cords using a small mirror or a flexible tube with a camera (laryngoscopy). This is done in an ear, nose, and throat (ENT) clinic. You may also have tests to find out what caused the nerve damage.

Tests that may be done

• Laryngoscopy (looking at the vocal cords with a flexible scope)
• Imaging scans (such as X-ray, CT scan, or MRI) to check the neck and chest
• Blood tests to look for infection, thyroid problems, or autoimmune conditions
• Nerve testing (electromyography, or EMG) to measure electrical activity in the vocal cord muscles
• Swallowing assessment (videofluoroscopy) if swallowing is affected

What to expect at your appointment

Your doctor may reassure you that you are on the right path. You will probably be referred to an ENT specialist and a speech-and-language therapist. These experts will explain your options. You should expect to have a clear plan for managing your voice, swallowing, and breathing.

Treatment

Treatment for vocal cord paralysis depends on the cause, how severe the symptoms are, and whether one or both cords are affected. The main options are voice therapy, injections or procedures, and sometimes surgery. Many people improve with voice therapy alone, and some recover on their own within a year.

Self-care at home

• Rest your voice when it feels tired
• Drink plenty of water to keep your throat hydrated
• Avoid smoking and exposure to second-hand smoke
• Use a humidifier at home to keep air moist
• Use a gentle voice technique (e.g., speak slowly, not forced)
• If swallowing is difficult, eat smaller bites and chew thoroughly

Medical treatments

Your doctor may suggest a referral to a speech-and-language therapist (also called a speech therapist) for voice exercises. For some people, an injection of a bulking agent into the vocal cord can improve movement temporarily. This is an option that your specialist can discuss with you. There are also procedures to reposition the vocal cord. Your doctor will explain what is suitable for your situation. No medication specifically fixes vocal cord paralysis, but medicines to treat the underlying cause (such as a nerve condition) may help. Always follow your doctor's advice about any prescribed treatment.

When is surgery considered?

Surgery is considered if voice and breathing problems are severe, or if both vocal cords are affected and cause difficulty breathing. There are operations to move the vocal cord closer to the midline or to create more space for breathing. These are usually done by specialists in ear, nose, and throat surgery. Your specialist will explain the benefits and risks.

Living with this condition

Adjusting to vocal cord paralysis can take time. You may need to find new ways to communicate, such as using a voice amplifier, writing, or using a smart speaker. Arranging your home so you do not have to shout across rooms can also help.

Lifestyle tips

• Give your voice regular breaks during the day
• Avoid whispering, which can strain your vocal cords
• Use a noise-cancelling microphone or phone speaker for important calls
• Let friends and family know about your condition so they can be patient with you
• If you smoke, getting support to quit is one of the best things you can do for your throat

Diet and exercise

Keep meals relaxed and take small bites if swallowing is an issue. Sit upright and eat slowly. It may help to alternate dry foods with sips of liquid. Gentle exercise like walking is usually fine, but if you get short of breath during activity, check with your doctor before continuing a vigorous exercise routine.

Mental health and emotional wellbeing

Vocal cord paralysis can affect your confidence and social life. You may feel embarrassed about your voice or frustrated when you cannot communicate as easily. These feelings are normal. It is important to talk about them. If you feel low or anxious most of the day, for more than two weeks, speak to a healthcare professional. You can also reach out to a mental health support line in your area. In an emergency, always call your local emergency number.

Prevention

Not all causes can be prevented, because some happen after surgery, stroke, or infection. However, you can reduce your risk of conditions that affect the nerves by protecting your neck from injury, keeping your blood pressure healthy, and not smoking. If you are having surgery on your neck or chest, your surgeon will take care to avoid the nerve, but please discuss any concerns before the operation.

Vaccines

Staying up to date with recommended vaccinations may reduce the risk of nerve damage caused by infections such as flu or certain viruses. Ask your pharmacist or local health service what you are eligible for.

Screening programmes

There is no routine screening test for vocal cord paralysis. But if you notice a change in your voice lasting more than a few weeks, get it checked.

Complications

If left untreated

• Pneumonia from food or drink going down the wrong way (aspiration)
• Chronic breathing problems, especially with both cords affected
• Loss of ability to communicate effectively, leading to social isolation
• Malnutrition or dehydration if swallowing becomes very difficult
• In severe cases, respiratory failure

Long-term outlook

The outlook depends on the cause. Many people recover full voice function within a year, especially if the nerve damage is temporary. Others may continue to have a weaker voice, but with voice therapy, most people can communicate effectively again. Even if the paralysis does not fully reverse, treatment can greatly improve quality of life. You will have a care team to help you at every step.

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