vocal cord paralysis

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Vocal Cord Paralysis

 

Definition

Vocal cord paralysis is the inability to move the vocal cords and the resulting loss of vocal cord function.

Description

The vocal cords are a pair of tough, fibrous bands that lie across the air column in the middle of the voice box. They assist three functions: breathing, swallowing, and speaking. When vocal cords vibrate, they produce sound, allowing us to speak. Vocal cords temporarily stop breathing to aid coughing and for expelling foreign objects. During swallowing, the vocal cords shut the airway so that food is not inhaled. When vocal cords are paralyzed, all three functions are affected.
The relaxed position of the vocal cords is halfway open. There is one set of muscles that closes them all the way and one set that opens them. Each set of muscles is controlled by a different nerve. Each nerve comes from a different direction—one from above and one from below (the recurrent laryngeal nerve). Vocal cords can either be partially paralyzed on one side or completely paralyzed on both sides.

Causes and symptoms

Vocal cord paralysis can result from injury, tumors, or surgery in the neck and upper chest. Brain tumors and stroke can also affect the nerves. Infectious diseases that damage nerves—like whooping cough, tetanus and polio—can also cause vocal cord paralysis. Vocal cord paralysis can also appear as a congenital defect. If congenital, the most frequent cause is a brain defect, which can often be effectively treated.
The most dangerous form of vocal cord paralysis is one that affects the opening function, controlled by the recurrent laryngeal nerve. If both vocal cords are paralyzed, breathing stops or becomes very labored. Fortunately, injury during trauma or surgery often involves only one side, but the congenital causes can damage both sides.
Vocal cord paralysis produces several symptoms.
  • The voice is always affected; at best it is breathy and weak. At worst, it is not there at all. In infants, the cry can be weak. Older children will suppress laughing and coughing because it is hard to do.
  • Swallowing may be hindered so that food ends up in the airway, causing violent coughing and often leading to pneumonia.
  • Breathing is obstructed on inspiration, producing a condition known as stridor. Closing the airway while breathing in produces creaking noises in the throat and changes the shape of the chest. The breast bone is drawn inward, much more visibly in the flexible chest of a small child.

Diagnosis

The voice box must be observed during breathing to characterize the problem. A viewing instrument called a laryngoscope, either flexible or rigid, is passed through the nose or throat until the cords becomes visible. The motion of each cord can then be seen, and other problems in the area identified.
X rays, CT, or MRI scans of the skull may be done if a brain disorder is suspected.

Treatment

An adequate airway is immediately necessary, usually secured with an endotracheal tube in the windpipe. If a cure cannot be achieved, a permanent breathing hole (tracheostomy) is cut in the neck. Brain problems that are relieved within 24 hours usually allow the cords to regain their function. Care must be taken to assure that swallowing takes place normally.

Alternative treatment

Vocal cord paralysis can be addressed with constitutional homeopathy. This will work with the whole person, not just the symptoms, to help bring about healing. Botanical medicine and deep tissue massage to the area can also bring some resolution, although it may not be long term.

Resources

Books

Ballenger, John Jacob. Disorders of the Nose, Throat, Ear, Head, and Neck. Philadelphia: Lea & Febiger, 1991.

Key terms

Computed tomography (CT scan) — Computerized use of x rays to create images of internal organs.
Laryngoscope — A diagnostic instrument that is used to examine the interior of the larynx.
Magnetic resonance imaging (MRI) — Computerized use of magnetic fields and radiofrequency signals to create images of internal organs.
Recurrent laryngeal nerve — One of two offshoots of the vagus nerve that connect to the larynx. It is located below the larynx.
Stridor — A raspy sound that occurs during respiration when the airways are blocked.
Tracheostomy — Surgical opening in the neck to the trachea to aid respiration.
Voice box — The larynx.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

vocal cord paralysis

Audiology Inability of one or both vocal folds (cords) to move because of brain or nerve damage. See Phonation.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
References in periodicals archive ?
Occasionally, you can detect the odd strain in the voice as the 77 year old reaches those memorable high spots, but for a man who lost his voice due to vocal cord paresis, which took four years to conquer, it's a minor miracle that he can still produce these moments that send shivers down your spine.
He gives additional prayerful thanks when he recovers, in 2014, from a potentially career-ending bout of vocal cord paresis. His sense of gratitude is best expressed in the poem that gives the book its title: "The beauty of light finds a room in us," he writes, "what is it all but luminous?" Lines like this demonstrate Garfunkel's own impressive talents as a writer.
Vocal cord paresis results from injury to the ipsilateral recurrent laryngeal nerve, a branch of the vagus, at any point along its course, with resulting dysphonia.
Other causes of VCP like traumatic or forceps delivery, mediastinal surgery, and ligation of patent ductus arteriosus, brainstem anomalies, and intracranial bleeding were not present in our case, and hence the diagnosis of idiopathic congenital bilateral vocal cord paresis was made.
Recessive GDAP1 mutations have a more severe phenotype and an early onset, before age 10; vocal cord paresis, facial weakness and diaphragmatic paralysis are common features (12).
The main phenotype features described of the patients with the GDAP1 Q163X mutation (15) are, a clinical onset in childhood with weakness and foot and hand wasting, an axonal pattern on nerve conduction velocities, hoarse voice and vocal cord paresis with onset in the second decade of life, and normal intelligence.
Mitrovic [3] found that vocal cord paresis was most often due to a neck surgery (strumectomy) in 38% of patients, and idiopathic causes followed immediately, being found in 24% of patients.
Glottal closure is a very complex mechanism; therefore, glottal disclosing by unilateral vocal cord paresis is an important parameter of phonation dysfunction.
Often, cases are misdiagnosed as vocal cord paresis, laryngeal oedema or laryngospasm.
A differential diagnosis of airway oedema, laryngospasm, vocal cord paresis and arytenoid subluxation was entertained.
Associated clinical features included vocal cord paresis, facial weakness, prominent chest deformities, claw hands, and a family history consistent with autosomal recessive inheritance.
Transient unilateral vocal cord paresis developed in 11 (3.2%) cases, and in one case (0.3%) it became permanent (post Rt.