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What Is Vocal Fold Paralysis?

Vocal fold (or vocal cord) paralysis occurs when your vocal folds, the two bands of tissue in your larynx (voice box), stop moving. Usually, this occurs because one or both of the nerves that go to your vocal folds stop working properly. When your vocal folds are damaged or paralyzed, you may have difficulty speaking, breathing, or swallowing.

Your vocal folds—also called your vocal cords—have several important functions:

  • Allowing you to speak and make sounds
  • Helping air flow freely in and out of your trachea (windpipe)
  • Preventing food, liquid, or other substances from entering your airway

Types of Vocal Fold Paralysis

There are two types of vocal fold paralysis:

  • Bilateral vocal fold paralysis occurs when both vocal cords become immobile, which may cause severe changes that affect your breathing.
  • Unilateral vocal fold paralysis is when immobility affects only one of your vocal cords, which often causes noticeable changes in your voice and swallowing.

Vocal Fold Paralysis Causes

You have nerves on each side of your neck extending from your brain to the upper portion of your chest. From your chest, these nerves loop back up to connect to your vocal cords. These nerves, called the vagus nerves, help control your voice, breathing, and swallowing. Injury or damage to the vagus nerves can potentially cause vocal fold paralysis.

One of these experiences may affect your vagus nerve:

  • Neck, spine, or thoracic (chest) surgery
  • Stroke
  • Viral infections
  • Trauma to the neck
  • Scar tissue buildup after intubation (having a breathing tube)
  • Tumors that affect your head or neck

Vocal Fold Paralysis Symptoms

The symptoms of vocal fold paralysis can vary depending on whether one or both vocal cords are affected. If you have one paralyzed vocal fold, you may experience one of the following symptoms:

  • Difficulty projecting your voice or shouting
  • Sensation of running out of air while speaking
  • A softer or breathier voice
  • Swallowing problems (dysphagia), such as choking on liquids more easily
  • Vocal fatigue

The most common symptom of bilateral vocal fold paralysis is a feeling of restricted breathing. You may feel it’s harder to get enough air or notice your breathing is noisy.

Why Choose University of Utah Health?

The Voice Disorders Center includes a dedicated team of physicians and speech language pathologists. They work together to treat complex voice, swallowing, and airway disorders. Only a small group of speech language pathologists nationwide specialize in these conditions. Our laryngologists have subspecialty fellowship training in medical and surgical management of voice, swallow, and airway disorders. They offer you the most advanced treatments to work toward restoring voice and swallow function.

You will often receive a coordination evaluation with our surgeons and speech language pathologists during your initial consultation. We will work together to develop the most effective treatment plan for your needs. When needed, you have access to subspecialists across U of U Health who help improve your health and quality of life.

Find a Voice Disorder Specialist

When to See a Voice Disorder Specialist

The American Academy of Otolaryngology recommends seeing an ear, nose, and throat specialist any time you experience voice changes lasting six weeks or longer. You may see your primary care provider sooner, especially if symptoms significantly disrupt your daily life.

Vocal Fold Paralysis Diagnostic Tests and Evaluation

Your voice disorder specialist will take a full medical history and ask about your symptoms. They also will perform a complete head and neck exam. They may also complete additional tests:

  • Flexible laryngoscopy/stroboscopy, where they will pass a thin, flexible camera through your nose to look at your throat and voice box
  • Imaging, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), to get a closer look at your head and neck
  • Laboratory tests, such as blood tests, to check for underlying conditions that could cause nerve problems

Vocal Fold Paralysis Treatment

Your treatment plan will depend on a few factors:

  • The underlying cause of vocal fold paralysis
  • What type of vocal fold paralysis you have
  • Whether your specialist expects your symptoms to be temporary or long-lasting

Your treatment may include observation and watchful waiting, where your specialist will observe you to see if symptoms improve. You may have in-office procedures or surgery to improve your voice. Additionally, your specialist will work with you to find the best treatment to improve your breathing symptoms.

Speech Therapy for Vocal Fold Paralysis

Sometimes voice therapy can be helpful for unilateral vocal fold paralysis. Your provider and speech language pathologist will work together to determine if exercises help improve voice or swallowing issues. 

Vocal Cord Paralysis Surgery

You may benefit from surgery, depending on your symptoms and the underlying cause of paralysis. Our laryngologists will discuss what the best treatment may be for you. We preform a range of surgeries:

  • Vocal cord injections—Your surgeon will inject the affected vocal fold with a substance that helps to bulk up the paralyzed vocal cord. This brings your vocal cord closer to the middle of your voice box. This will help your vocal folds close more easily.
  • Medialization laryngoplasty—Your surgeon will make an incision in your neck. Then they will place a permanent implant next to your voice box to reposition your vocal cord.
  • Reinnervation—Your surgeon will use a branch of another nerve in your neck and connect it to the nerve that goes to your voice box.  

Vocal Cord Paralysis Surgery Recovery Time

Vocal fold surgeries typically include at least one night in the hospital after surgery. You typically are able to eat soft foods, drink, and gently use your voice after surgery. Avoid heavy lifting for at least two weeks after the procedure. Full recovery usually takes at least six weeks.

Vocal Cord Paralysis Surgery Success Rate

The success of vocal fold surgery depends on the underlying cause of vocal fold paralysis. Your surgeon will help you understand what results you can expect after surgery for your individual case.

Refer a Patient to a Voice Disorder Specialist

You will need a physician referral to see a voice disorder specialist. Physicians can call 801-587-3550 to refer a patient or fill out an online referral.

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