vocal cord paralysis


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Related to vocal cord paralysis: Vocal Cord Dysfunction

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.

vocal cord paralysis

Audiology Inability of one or both vocal folds (cords) to move because of brain or nerve damage. See Phonation.
References in periodicals archive ?
The global vocal cord paralysis market is expected to exhibit a 3.8% CAGR from 2018 to 2023 (forecast period), as per the latest report by Market Research Future (MRFR) owing to prevalence of brain disorders.
Technique of endo-extralaryngeal suture lateralization for bilateral abductor vocal cord paralysis. Laryngoscope 1997;107:1281-3.
Conclusion: Vocal cord paralysis is a common clinical condition with substantial morbidity.
TABLE 1: Neonatal stridor due to congenital bilateral vocal cord paralysis: clinical associations reported in literature.
Based on previous studies, we investigated the quality of voice and speech in patients with bilateral vocal cord paralysis after partial arytenoidectomy with posterior cordectomy.
Finally, although the link between vocal cord paralysis and the occurrence 11 months later of severe MPO-ANCA disease cannot be definitively established as causal, the lack of evidence for an alternative origin of the laryngeal disease, the presence of MPO-ANCA from the start, the improvement associated with glucocorticoids and immunosuppressants, and the long-term follow-up confirming the diagnosis of MPA, lead us to believe that the most likely explanation of the cordal paralysis was related to involvement of the recurrent laryngeal nerve by MPA.
The on-off movement of bilateral vocal folds was synchronized in the intact condition (Figure 5(a)), and such synchronization was disrupted by left RLN injury (Figure 5(b)), that is, no movement of left side vocal fold, indicating effective unilateral vocal cord paralysis. Importantly, when using the feedback signals of EMG envelopes from left (injured side) CT muscle, the movement of left (injured) vocal fold was restored and synchronized with the healthyside (Figure 5(c)).
Following induction, the patient was intubated under direct laryngoscopy with a cuffed tracheal tube, ID 6.5 mm, after observing that there were no laryngeal or pharyngeal abnormalities besides the left vocal cord paralysis via a fiber-optic bronchofiberscope.
She had extensive local involvement of the disease with involvement of the oropharynx (manifested with dysphagia and difficulty in opening mouth), larynx (manifested by cough and hoarseness) with right vocal cord paralysis. Vocal cord paralysis was a little unusual for us as we did not find a case report of Lemierres disease with vocal cord paralysis and hence other diagnosis like vasculitis and granulomatosis with polyangiitis were also considered in the differential diagnosis and excluded appropriately.
A temporary choking that presented before surgery lasted for half an year after surgery, permanent right vocal cord paralysis and slight ptosis on the right side were also observed.
Total thyroidectomy is the usual treatment for thyroid cancer, subjecting patients to risk of complications such as permanent hypoparathyroidism and vocal cord paralysis. In addition, patients require thyroid hormone therapy and monitoring for the rest of their lives when the thyroid is removed.