What Is Vocal Cord Paralysis?
Vocal cord paralysis, also called vocal fold paralysis, is a condition that affects the working of the voice box muscles. Because of this condition, the opening and closing of the muscles in the voice box are not in control. This is because of nerve damage that they are not able to control the movements of the muscle. This will result in paralysis of the muscles of the vocal cords. Several diseases can result in this condition.
The vocal cord has the function of preventing food, liquid, and saliva from entering the windpipe, so when this muscle is paralyzed, they do not function properly. This can result in food, liquid, and saliva entering the windpipe and causing one to choke. They are also involved in the production of sound. In the majority of cases, one vocal fold is seen to be involved. This can cause swallowing and breathing difficulty. When both vocal cords are involved, then it can result in life-threatening breathing conditions.
What Are Vocal Cords?
Vocal cords are flexible, thin muscles of the voice box. The larynx, which is also known as the voice box, is located above the trachea, that is, the windpipe, and at the back of the throat. There are two vocal cords present inside the larynx. The vocal cords move apart to allow airflow that is while breathing and are tightly closed while we swallow. When one tries to speak, the vocal cords close, and the air is sent from the lungs causing them to vibrate and make sounds.
Vocal cords play a major role in talking, swallowing, and breathing. When any one of the vocal cords is paralyzed, that cord remains open, which can result in the entry of food and saliva into the windpipe. When both the vocal cords are paralyzed, they remain closed, which will narrow down the air passage accusing breathing difficulty and can be fatal.
What Are the Causes of Vocal Cord Paralysis?
Vocal cord paralysis can result from nerve damage which can be caused due to several conditions, diseases, injuries, and infections which include:
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Injury During Surgery to the Vocal Cords- Surgeries in the upper chest and neck pose the risk of causing injury to the nerve supplying the muscle of the vocal cord. Surgeries of the thyroid, parathyroid, esophagus, neck, and chest pose a risk of nerve damage.
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Neck or Chest Injury- Trauma to the neck and chest region can cause injury to the nerves.
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Stroke- Stroke can interrupt the blood flow to the brain and can cause damage to the center that sends signals to the voice box.
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Tumors- Tumors that may grow in and around the voice box can interfere with the working of vocal cords and can result in paralysis.
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Infections- Infections such as Lyme’s disease, herpes, and Epstein-Barr virus can damage the nerves and result in this condition.
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Neurological Conditions- Neurological conditions like Parkinson’s disease (a disease affecting the nervous system resulting in tremors of the body parts) or multiple sclerosis (the immune system attacks the protective covering of the nerve cells) can cause vocal cord paralysis.
What Are the Symptoms of Vocal Cord Paralysis?
Vocal cord paralysis symptoms range from mild to severe, and sometimes the symptoms are relieved on their own and, in some cases, worsen over time. The signs and symptoms of vocal cord paralysis include:
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Hoarseness.
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Noisy breathing.
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Difficulty when trying to speak loudly.
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Need to take a break while speaking continuously to catch the breath.
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Loss of vocal pitch.
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Frequent throat clearing.
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Coughing or choking while swallowing food, liquid, or saliva.
What Are the Complications Associated with Vocal Cord Paralysis?
There may be breathing difficulty associated with vocal cord paralysis. If it is mild, then it may not cause any serious condition; it can cause a change in the voice like there will be hoarseness of the voice, or it can cause life-threatening conditions in case of severe paralysis and when both the cords are affected.
When there is vocal cord paralysis, the vocal cords remain open or completely closed. This can cause difficulty in breathing and can also cause aspiration pneumonia by allowing food and other particles to enter the trachea and windpipe and thereby causing infection. This can be a serious complication of vocal cord paralysis.
How Is Vocal Cord Paralysis Diagnosed?
The healthcare providers may ask for the medical history and the severity of the symptoms to reach a diagnosis. They may also order further investigations, such as:
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Laryngoscopy- Laryngoscopy is done by inserting a thin, flexible tube into the nose with a camera at the end. The healthcare providers can view the vocal cords on the monitor that is attached to the camera and observe their movements and position.
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Laryngeal Electromyography (LEMG)- This test measures how the nerves control muscles in the voice box. It records the electrical impulse received in the muscles.
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Imaging Test- Imaging tests like CT (computed tomography) or MRI (magnetic resonance imaging) scanning may be done on the brain, throat, voicebox, thyroid gland, and chest.
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Blood Tests- Blood investigation may also be ordered as this can be caused due to some autoimmune disorders or infections.
How Is Vocal Cord Paralysis Treated?
The treatment of vocal cord paralysis depends upon the cause, severity of symptoms, and the onset of the symptoms. The treatment options are discussed below:
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Voice Therapy- Voice therapy involves exercises and other therapies to strengthen the muscles of the vocal cord, improve breath and speech, and protect the airway during swallowing. Sometimes voice therapy is the only treatment needed when the paralysis has affected a part that does not cause any other complications.
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Surgery- Surgery is considered when the vocal cords do not fully recover on their own. Surgical treatment options include:
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Bulk Injections- In this procedure, a doctor will inject filler materials such as body fat, collagen, or other approved filler materials. This filler material brings the affected vocal cord near the midline so that the other unaffected vocal cord can make contact with the other one during speaking, swallowing, and breathing.
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Vocal Cord Repositioning- In this procedure, the surgeon repositions the paralyzed vocal cord near the midline so that the unaffected vocal cord can come in proximity and vibrate better against the paralyzed partner.
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Structural Implants- Instead of a bulk injection, this procedure uses an implant in the larynx to reposition the vocal cords.
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Nerve Reinnervation Surgery- In this surgery, a healthy nerve that is present in the neck is moved to supply the vocal cord also. By doing so, the other muscles in the neck are not affected. This procedure is helpful in children with vocal cord paralysis.
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Tracheostomy- When both the vocal cords are paralyzed, then this procedure is done. In tracheostomy, an incision is made in the trachea, and a windpipe is inserted in order to assist in breathing.
Conclusion
If one has any symptoms related to vocal cord paralysis, like breathing difficulty, change in voice, and swallowing difficulty, do consult a doctor. Paralysis of both vocal cords can be fatal, which is rare. When the diagnosis is made earlier, the healthcare provider can help manage the symptoms in a better way and also to start any treatment if required sooner.
