Vocal Cord Paralysis

Diagnosis

To diagnose vocal cord paralysis, your healthcare professional begins by asking about your symptoms, voice changes, and lifestyle. A physical exam and voice evaluation help determine how long and how severely your voice has been affected.

You may need several specialized tests, including:

• Laryngoscopy: This involves examining the vocal cords using a mirror or a thin, flexible tube called a laryngoscope or endoscope. A test known as videostrobolaryngoscopy may also be performed, using a high-magnification scope with a camera that provides a detailed view of the vocal cords and their movement. These tests help determine whether one or both vocal cords are affected.

• Laryngeal electromyography (EMG): This test measures the electrical activity of the muscles in your voice box. Small needles are inserted through the skin of the neck into the vocal cord muscles. Although this test doesn’t guide treatment, it can estimate recovery potential and is most useful when done between six weeks and six months after symptoms begin.

• Blood tests and imaging scans: Since nerve injuries can result from other underlying conditions, tests like bloodwork, X-rays, MRI, or CT scans may be recommended to identify the cause of the paralysis.

Treatment

Treatment for vocal cord paralysis depends on the cause, severity of symptoms, and how long the condition has been present. Options include voice therapy, bulk injections, surgery, or a combination of treatments.

In some cases, symptoms may improve without surgical intervention. Because of this, permanent surgery is often delayed for up to a year after diagnosis. However, temporary treatments like bulk injections may be recommended within the first three months. During this period, voice therapy is often used to support recovery and prevent strain.

Voice therapy

Voice therapy involves guided exercises designed to strengthen the vocal cords and improve breath control. It helps reduce muscle tension around the affected vocal cord and protects the airway during swallowing. In some cases, voice therapy alone may be enough if the paralysis does not require additional surgical correction.

Surgery

If recovery does not occur naturally, surgical treatments may be needed to restore speech and swallowing ability. Common procedures include:

• Bulk injection: A laryngologist may inject a filler material such as body fat, collagen, or another approved substance into the paralyzed vocal cord. This adds volume and brings it closer to the middle of the voice box, improving contact with the healthy vocal cord.

• Structural implants (thyroplasty or medialization laryngoplasty): An implant is placed in the larynx to reposition the paralyzed vocal cord. Some people may require a follow-up procedure to adjust the implant’s position.

• Vocal cord repositioning: This procedure involves moving a section of tissue from outside the voice box inward, pushing the paralyzed vocal cord toward the center to help the functioning cord vibrate effectively.

• Reinnervation surgery: A healthy nerve from another part of the neck is connected to the paralyzed vocal cord to restore function. Recovery can take six to nine months, and sometimes this procedure is combined with a bulk injection.

• Tracheotomy: If both vocal cords are paralyzed and airflow is severely reduced, a tracheotomy may be necessary. This involves creating an opening in the front of the neck and inserting a breathing tube to allow air to bypass the vocal cords.

Emerging treatments

Researchers are exploring new treatments that use electrical stimulation to help restore movement to paralyzed vocal cords. These approaches may involve connecting the vocal cords to another nerve or using a device similar to a pacemaker to control their motion. These options remain experimental but show promise for future therapy.

Coping and support

Living with vocal cord paralysis can affect speech, confidence, and quality of life. Working with a speech-language pathologist or support group can help manage emotional and practical challenges. Regular follow-ups with a healthcare professional are important to monitor progress and adjust treatment as needed.