Vocal Cord Paralysis: what it is, symptoms and treatment

A voice that suddenly becomes weaker, hoarse, or almost whispered. Frequent choking on liquids. Shortness of breath when speaking or even at rest. These are some signs that may be linked to vocal cord paralysis, a condition that many people are unaware of until they receive a diagnosis.

Vocal cord paralysis occurs when one or both vocal cords stop moving as they should, due to damage to the nerves that control them or mechanical immobility of the larynx. This can affect the voice, breathing, and swallowing, directly impacting safety and quality of life. 

In this article we will explain, in simple language, what vocal cord paralysis is, what the main symptoms and causes are, how it is diagnosed, what treatment options exist, and what role speech therapy plays in the recovery process.

Vocal cord paralysis: what is it?

When we talk about vocal cord paralysis, we are referring to the partial or total loss of mobility in one or both vocal cords. This loss of movement results, in most cases, from damage to the recurrent laryngeal nerve or other nerve structures that control the larynx. 

In general, it could be:

• unilateral

  • Only one vocal cord is paralyzed.

  • This is the most frequent form.

  • It primarily affects voice quality and can cause choking.

• bilateral

  • both ropes are paralyzed.

  • It is less frequent, but much more serious.

  • It can cause airway obstruction and significant shortness of breath. 

In unilateral vocal cord paralysis, the voice usually sounds breathy, weak, and strained when speaking. In bilateral vocal cord paralysis, respiratory symptoms often take center stage, with dyspnea, wheezing, and, in extreme cases, an emergency situation.

Main causes of vocal cord paralysis

Vocal cord paralysis is not a single disease, but rather a sign that something is affecting the nerves or the larynx itself. Among the most common causes described in the literature are: 

• Surgeries in the neck and chest area

  • thyroidectomy

  • cardiac and vascular surgeries

  • esophageal or cervical spine surgeries
    Iatrogenic injuries to the recurrent laryngeal nerve are one of the most frequent causes.

• Tumors and compressive masses

  • tumors of the thyroid, larynx, lung, or mediastinum

  • large lymph nodes
    They can compress or infiltrate the nerve, leading to unilateral or bilateral damage.

• Trauma

  • cervical trauma

  • injury to the larynx or trachea

  • difficult or prolonged intubations

• Stroke and neurological diseases

  • bulbar stroke

  • degenerative diseases such as Parkinson's disease or amyotrophic lateral sclerosis

  • other demyelinating diseases or cranial neuropathies

• Infections and inflammatory causes

  • viral infections with neurological tropism

  • Inflammatory processes that affect peripheral nerves.

• Congenital and pediatric causes

  • malformations of the central nervous system

  • structural changes of the larynx

  • injuries associated with cardiothoracic surgery in childhood 

• Idiopathic cases
  In many patients, despite extensive investigation, no clear cause is found. In these cases, the term idiopathic paralysis or possibly post-viral paralysis is used.

Understanding the cause is fundamental to defining the prognosis and guiding medical, surgical, and speech therapy treatment.

Symptoms of vocal cord paralysis

The symptoms of vocal cord paralysis vary depending on:

• whether it is unilateral or bilateral

• the position in which the strings are "tied"“

• the time of evolution

• the existence of compensations in the larynx and other muscles

When vocal cord paralysis is unilateral

In unilateral cases, the most frequent symptoms include: 

• persistent hoarseness

• weak, breathy voice, "as if air were escaping"“

• difficulty in projecting the voice

• Vocal fatigue increases rapidly when speaking.

• sensation of strain or tightness in the throat

• choking, especially on liquids.

• ineffective cough and difficulty clearing the throat

These signs can be confused with functional hoarseness, for example in the initial stages of vocal abuse. That's why it's also very useful to know if it is... hoarseness, which helps to understand the differences between functional changes and structural conditions such as vocal cord paralysis.

When vocal cord paralysis is bilateral

In bilateral vocal cord paralysis, the primary concern is often breathing. Symptoms include: 

• shortness of breath even with slight exertion

• respiratory noise (stridor)

• a feeling of "tightness" in the throat

• weak or broken voice

• possible dysphagia and choking

In these cases, it can represent a true medical emergency, requiring rapid assessment in a hospital setting.

Complications and impact of vocal cord paralysis

Vocal cord paralysis doesn't just affect how a person sounds. It can lead to significant complications in several areas:

• Swallowing safety

  • increased risk of food and liquids getting in and being aspirated

  • cough after swallowing

  • Aspiration pneumonia, in more severe cases

• Social and professional participation

  • difficulty in speaking on the phone, teaching classes, and serving clients.

  • This has a particular impact on voice professionals, who can benefit from specific programs such as professional voice for teachers

• Quality of life

  • constant effort when speaking

  • limitations in activities that require stamina

  • anxiety related to breathing or fear of choking

When it affects food safety, it is essential to assess signs of dysphagia and, if necessary, integrate specific guidelines on food consistencies and feeding strategies to reduce the risk of complications.

Diagnosis of vocal cord paralysis

When vocal cord paralysis is suspected, diagnosis always requires a specialized evaluation by an otolaryngologist, often in collaboration with a specialist. speech therapist.

The main steps include: 

• Detailed medical history

  • onset and progression of symptoms

  • recent surgeries on the head, neck or chest

  • neurological diseases, recent infections, trauma

• Observation and evaluation of the voice

  • analysis of vocal quality (breathiness, hoarseness, effort)

  • ability to project the voice and maintain long sentences

  • impact on daily life

• Larynx examination

  • laryngoscopy or videolaryngostroboscopy

  • It allows direct observation of the movement, the position of the vocal cords, and the degree of glottal closure.

• Additional tests

  • Imaging tests (ultrasound, CT scan, MRI) are used when tumors or neurological lesions are suspected.

  • Laryngeal electromyography is used, in some cases, to assess the condition of the nerves and muscles of the larynx.

Based on this information, the doctor confirms whether paralysis is present, whether it is unilateral or bilateral, and what the most likely cause might be.

Treatment of vocal cord paralysis

Treatment for vocal cord paralysis depends on several factors:

• cause identified

• evolution time

• whether it is unilateral or bilateral

• impact on voice, breathing and swallowing

• age, profession and goals of the patient

In many cases, it combines medical, surgical, and speech therapy approaches. 

Medical approach and surveillance

In the first few months after the onset of vocal cord paralysis, some cases may recover partial or complete mobility spontaneously, especially when the etiology is inflammatory or post-viral. Therefore, the following may be recommended:

• Clinical monitoring with periodic reassessment.

• control of underlying diseases (e.g., neurological or endocrine)

• general vocal health measures

Even at this stage, speech therapy intervention can be initiated to improve vocal quality and compensate for glottal closure insufficiency.

Surgery for unilateral vocal cord paralysis

When vocal cord paralysis is unilateral and symptoms persist, the following may be considered:

• filler injections in paralyzed vocal cords

  • bring the vocal cords closer together

  • They reduce air leakage and improve the voice.

• medialization surgeries (such as thyroplasty)

  • They place the paralyzed rope in a more favorable position.

  • They allow for better contact between the vocal cords, resulting in improved voice and swallowing.

• reinnervation techniques

  • They aim to restore nerve control, especially in younger patients with a good overall prognosis.

Even after surgery, vocal cord paralysis continues to benefit from speech therapy follow-up to consolidate new vocal patterns.

Surgery for bilateral vocal cord paralysis

In bilateral vocal cord paralysis, the absolute priority is to ensure a secure airway. In many patients, especially when dyspnea and stridor are present, the following becomes necessary: 

• tracheostomy, temporary or permanent

• Posterior cordotomies or arytenoidectomies (often with laser) to increase breathing space.

• Reinnervation techniques, in specialized centers, seeking to balance breathing and vocal quality.

In these cases as well, speech therapy helps to reorganize how the patient uses their voice and to better coordinate breathing and speech after the intervention.

Vocal cord paralysis and other associated disorders

Vocal cord paralysis can occur in the context of neurological diseases where vocal cord paralysis also exists. dysarthria, That is, alterations in the articulation and overall coordination of speech. In these cases, speech therapy work encompasses not only the voice, but the entire verbal production.

Furthermore, it can coexist with more pronounced swallowing difficulties, making it essential to delve deeper into the topic through specific content such as dysphagia, to ensure food safety.

Finally, it is common for these patients to be monitored over time by their speech therapist, as described more comprehensively in the article on speech therapy, which better explains the role of this professional in various pathologies.

Daily care and strategies

Although the primary treatment plan for vocal cord paralysis is determined by medical and speech therapy teams, there are daily care measures that can help:

• Stay well hydrated throughout the day.

• Avoid shouting, speaking in very noisy environments, or straining your voice.

• Do not smoke and avoid exposure to smoke and irritants.

• Make vocal pauses, especially if your profession requires you to talk a lot.

• respect the strategies taught in speech therapy (posture, breathing, way of starting a sentence)

Professionals who rely heavily on their voice, such as teachers, communicators, or trainers, particularly benefit from the intersection between vocal cord paralysis management and the principles discussed in [reference to previous work]. professional voice For teachers, focusing on prevention and efficient use of the voice.

When to seek urgent help

Not all vocal cord paralysis is a medical emergency, but there are signs that require immediate attention: 

• significant difficulty breathing, even at rest.

• loud noise when inhaling

• Extreme fatigue when speaking short sentences.

• Repeated choking episodes with a weak cough, a feeling of "choking" when eating or drinking.

Given these signs, urgent medical attention should be sought quickly, ideally in an otolaryngology setting. From there, follow-up will be organized, including assessment and intervention in speech therapy.

Conclusion

Vocal cord paralysis is frightening, especially when sudden changes in voice or shortness of breath occur. But it's important to know that it doesn't mean "losing your voice forever.".

In most cases, with proper diagnosis, well-considered medical and surgical treatment, and structured speech therapy intervention, it is possible to significantly improve vocal quality, swallowing safety, and often reduce the need for invasive procedures.

If you have persistent symptoms that suggest vocal cord paralysis, don't ignore them. Seek specialized evaluation and learn about the role of speech therapy in your case. And, if distance or logistics are an obstacle, remember that online speech therapy is also available today, bringing specialized support closer to your daily life.

Taking care of your voice, breathing, and swallowing means taking care of basic functions we use at all times in life. Vocal cord paralysis is not the end of communication; it's a challenge that can be worked on, step by step, with the right team by your side.