What are the symptoms of vocal cord paralysis?
- Hoarseness (specifically, a breathy or quiet voice)
- Inability to project your voice or get loud
- Choking or coughing while swallowing food, drink, or saliva
- The need to take frequent breaths while speaking or feeling short of air while speaking
- Ineffective cough requiring frequent throat clearing
What causes my voice and swallowing to be different with a 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.
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.
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Vocal cords with complete closure
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Unilateral vocal cord immobility leading to "glottic gap"
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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.
What are the treatment options for vocal fold paralysis?
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 1 year to recover. After this period of time, if recovery has not happened, it is unlikely to recover.
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.
A 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.
In general, after a vocal cord paralysis has occurred, the nerve has up to 1 year to recover. After this period of time, if recovery has not happened, it is unlikely to recover.
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.
A 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.
Are there permanent options for vocal fold paralysis?
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. These include a permanent implant (silastic or goretex) 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 and there are no voice or diet restrictions post-operatively.
Some patients with a large glottic gap will require repositioning of the arytenoid (vocal cord joint) with an additional procedure called an arytenopexy. If this is required, patients are generally observed in the hospital overnight.
Dr. Burckardt will review your exam with you and determine which surgical procedure is the best option for you.
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.
Some patients with a large glottic gap will require repositioning of the arytenoid (vocal cord joint) with an additional procedure called an arytenopexy. If this is required, patients are generally observed in the hospital overnight.
Dr. Burckardt will review your exam with you and determine which surgical procedure is the best option for you.
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.