Vocal cord paralysis is a medical condition which affects the vocal folds in the voice box (larynx). The vocal cords are very important when it comes to one’s ability to speak, swallow, and breath. This condition occurs when the nerves that control the muscles in the vocal cords become paralyzed or function abnormally.
Vocal cord paralysis can affect either one or both vocal folds. When this happens, medical attention is required to restore the functionality of the vocal cord. The mode of treatment is usually determined after a definite diagnosis, with surgery being the most recommended option.
Causes of Vocal Cord Paralysis
Vocal cord paralysis is usually caused by an underlying medical condition. Some of the possible conditions or health events that can lead to the paralysis or abnormal functionality of the nerves controlling the muscles in the vocal cords include:
- Tumors: Both benign or cancerous tumors growing around the muscles or nerves in the voice box can lead to vocal folds paralysis
- Chest or neck injury: This attains to any kind of trauma that injures the nerves in the voice folds
- Neurological conditions: These include, but are not limited to Parkinson’s disease, Multiple sclerosis, and Myasthenia gravis (a neuromuscular disease that weakens skeletal body muscles)
- Stroke: A stroke occurs when there’s an obstruction of blood supply to the brain
- Injury to the vocal folds during a surgical procedure: Surgery to the neck, thyroid and parathyroid glands and esophagus can carry a risk of damaging the nerves in the larynx
- Infections: Certain infections such as herpes, and Lyme disease can damage the vocal cord nerves.
Symptoms of Vocal Cord Paralysis
Common symptoms of vocal cord paralysis, which can vary depending on whether one or both vocal folds are affected include:
- Shortness of breath
- Swallowing problems
- Hoarseness or loss of speech
- Noisy breathing
- Weak voice
- Choking while swallowing
- Unsuccessful coughing
- Loss of gag reflex
Diagnosis of Vocal Cord Paralysis
If you experience the above-mentioned symptoms, your primary care physician will refer you to an Ear, Nose and Throat specialist who will do evaluations based on your symptoms in order to arrive at a definitive diagnosis. The tests performed include:
Laryngoscopy
This is the first test that is usually done by an ENT specialist. He/she uses a laryngoscope, which is a long flexible tube to look at the vocal folds. Additionally, he can do a videostrobolaryngoscopy, which uses a scope that has a light and camera attached on its tip, to look at the condition and position of the vocal cords. The images of the vocal codes are then reflected on a monitor.
Laryngeal Electromyography
Also known as LEMG, the test measures the electric currents in the voice box muscles. To achieve this, small needles are inserted into the muscles of the larynx through the skin on the neck. During this procedure, the patient is asked to do a number of activities to activate the muscles. The LEMG test is mainly used to determine how the recovery will be after treatment.
Additional Tests
To help in determining the cause of the vocal cord paralysis, the ENT specialist may order other tests including blood tests, X-ray, CT scans and MRI scans.
Treatment of Vocal Cord Paralysis
Depending on the symptoms as well as the cause of the vocal cord paralysis, different treatment options are recommended. These can range from surgery, voice therapy and bulk injections, or a combination of these treatments.
Voice Therapy
Depending on the cause of the vocal cord paralysis, voice therapy is usually recommended as the first form of treatment in order to improve their function. Usually this is done during the first year after the onset of symptoms before having surgery in order to restore nerve communication between the brain and the voice box.
Surgery
If voice therapy does not help the recovery from vocal cord paralysis, then surgical options are recommended in order to improve the functions of the vocal folds. These surgical procedures include:
Tracheotomy
This procedure, which is also known as tracheostomy, is considered if both vocal folds are paralyzed. The procedure aims to access the windpipe by directly making an opening in the neck. A tube is then inserted to aid in breathing.
Vocal Cord Injections
Vocal cord paralysis can lead to the weakening of the muscles in the vocal folds. To make the folds bulkier, a substance such as body fat is injected in order to make them easier to move. The procedure is done via the surrounding skin that covers the voice box.
Repositioning of the Vocal Folds
This procedure is recommended when one of the vocal cords is paralyzed. During the surgery, tissue from outside the larynx are moved inwards and the paralyzed vocal fold is pushed towards the center of the voice box, allowing the healthy fold to function (vibrate) against the paralyzed one.
Laryngeal Framework Surgery
Also known as medialization laryngoplasty, this procedure uses implants to reposition the vocal fold. The said implant is inserted into the voice box through an incision on the neck whereby it moves the folds closer to help them vibrate better.
Next Step
At King’s College Hospital Dubai, we focus on offering an exemplary service from initial consultation through to the final diagnosis and treatment and beyond. Our team of expert doctors and nurses are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.
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