Adult onset vocal cord (or fold) paralysis is due to abnormal nerve input to the laryngeal muscles. The associated nerves are the superior laryngeal nerve and the recurrent laryngeal nerve. The superior laryngeal nerve carries signals to the cricothyroid muscle. The recurrent laryngeal nerve carries signals to different voice box muscles responsible for breathing, coughing, swallowing and vibration during voice use. This nerve is involved in the majority of cases of vocal cord paralysis.
Adults suffering from vocal cord paralysis use a lot of effort when trying to speak. They have weak, breathy voices, and experience coughing and choking while eating or drinking. Recurrent pneumonia may occur in some individuals.
There are a variety of causes for vocal cord paralysis including inadvertent injury during neck or chest surgery, complication from endotracheal intubation, blunt neck or chest trauma, tumors of the skull base, neck, and chest, viral infections, or arytenoid fixation. A large percentage of cases are idiopathic.
There are several treatment options for vocal cord paralysis. The preferred option depends on each patient’s individual condition.
- Voice therapy is often the first recommended treatment protocol. This therapy utilizes exercises to strengthen a patient’s vocal cords, improve breath control during speech, or protect the airway during swallowing.
- Bulk injections of body fat, collagen or other approved substance through the mouth or neck are used to push the affected vocal cord closer to the middle of the voice box so that the functioning, moving vocal cord can make closer contact with the paralyzed cord when a patient speaks or swallows.
- Medialization thyroplasty is an outpatient procedure which utilizes an implant device to push the paralyzed vocal cord toward the middle of the voice box. Because this procedure does not disturb the movement of the tissue that lines the vocal cord, it helps preserve the voice.
- A tracheotomy may be needed if the patient has trouble breathing due to bilateral vocal cord paralysis and the vocal cords are in a closed position.