VOCAL CORD PARALYSIS
VOCAL CORD PARALYSIS
What is vocal cord paralysis?
With a unilateral (one sided) vocal cord paralysis, one vocal cord is able to move and the other is not. Because of this, the vocal cords are unable to make contact. The lack of contact between the vocal cords is often referred to as a "glottic gap."
You can think of of a vocal cord immobility similarly to a leaky valve. The vocal cords are unable to close completely and this allows air to escape between them. With air escaping between the vocal cords, your voice is more breathy and quiet. It is also substantially more effort to produce speech. By the same logic, food and water are more likely to go into your lungs (aspiration) because you are unable to close your vocal cords effectively.
With a unilateral vocal cord paralysis, the position of the vocal cord is variable. The larger glottic gap that is present, the more symptomatic you will be.
VOCAL CORD PARALYSIS
How is vocal cord paralysis treated?
Treatment of vocal cord paralysis depends on how long the paralysis has been present and the etiology of the paralysis. In general, after a vocal cord paralysis has occurred, the nerve has up to a year to recover. After this period of time, if recovery has not happened, it is unlikely to recover.
Temporary Options: Injection Laryngoplasty (Vocal Cord Injection) and Voice Therapy
There are temporary treatment options that can be performed while we are waiting to determine if the vocal cord nerve will recover. These options include voice therapy and injection medialization laryngoplasty (vocal cord injection). These treatment options often work best if performed together.
Voice therapy
is the least invasive option and helps you to learn strategies to compensate for your immobile vocal fold.
Vocal cord injection
can be performed in the office in most patients. This requires just local numbing medication to the vocal cords and takes only a matter of minutes. The injected material pushes the immobile vocal fold into a more medial position so that it can make contact with the other vocal cord. This reduces the amount of air escaping between the vocal cords. This will strengthen your voice, reduce vocal effort, and decrease risk of aspiration.
Permanent Options
If you have had a long standing paralysis or enough time has passed that we believe vocal cord paralysis has become permanent, there are permanent options for vocal cord medialization.
A permanent implant (silastic or goretex) can be placed through a small incision in your neck into the larynx (voice box). The procedure is performed under mild sedation, so that we can confirm the change in your voice right away. The procedure is outpatient with no voice or diet restrictions post-operatively.
An arytenopexy
is required for patients with a large gap between their vocal cords. This procedure involves repositioning of the vocal cord joint (arytenoid). If this procedure is required, patients are generally observed in the hospital overnight.
Reference: Zeitels, SM., Adduction arytenopexy: a new procedure for paralytic dysphonia with implications for implant medialization. Ann Otol Rhinol Laryngol Suppl. 1998 Sep;173:2-24.
