© Shutterstock

What are vocal cords? -

Vocal cords consist of two bands of muscles located inside the larynx. They play a vital role in breathing, preventing food and drink from entering the windpipe, and in making sound (i.e. talking).

© Shutterstock

What is vocal cord paralysis (vocal fold paralysis)? -

Vocal cord paralysis, also known as vocal fold paralysis, occurs when one or both vocal cords don’t move as expected. This means that they don’t open or close as they should.

© Shutterstock

Types of vocal cord paralysis: unilateral -

There are two main types of vocal cord paralysis. Unilateral vocal cord paralysis occurs when one vocal cord is paralyzed. In which case, mostly breathing and swallowing are affected.

© Shutterstock

Types of vocal cord paralysis: bilateral -

Consequences can become more serious when both vocal cords are paralyzed. Because the cords usually swell very close together, the narrowed airway can cause serious difficulties in breathing.

© Shutterstock

How common is it? -

Unilateral vocal cord paralysis is the most common type of vocal cord paralysis. It can affect virtually anyone.

© Shutterstock

How serious is vocal cord paralysis? -

It depends on the severity of the case. It may manifest through more subtle symptoms, but it can also be potentially life-threatening. This is especially true when it affects swallowing and breathing.

© Shutterstock

Symptoms -

Symptoms vary depending on both the level of paralysis and the position of the vocal cords in relation to one another.

© Shutterstock

Symptoms: sound -

Symptoms that the vocal cords may under strain include a hoarse, scratchy, weak, or breathy voice.

© Shutterstock

Symptoms: pitch and volume -

Other symptoms include changes in vocal pitch and volume. Does your voice sound higher or lower than normal? Softer or louder?

© Shutterstock

Symptoms: breathing -

Loss of voice and shortness of breath (dyspnea) are also symptoms to look out for. So is noisy breathing (e.g. wheezing).

© Shutterstock

Symptoms: swallowing -

Further symptoms of vocal cord paralysis may include difficulty swallowing (dysphagia), choking while trying to swallow, and inability to clear the throat when coughing.

© Shutterstock

What does it feel like? -

In addition to the aforementioned symptoms, some people also experience fatigue, a constant feeling of having mucus in the throat, as well as the sensation of choking if food or drink falls into the windpipe.

© Shutterstock

Speaking -

Speaking is possible with vocal cord paralysis, but it may require more effort than normal.

© Shutterstock

Causes: injury -

There are a number of conditions that can damage the nerves that control the movement of vocal cords, including trauma induced by injury (i.e. neck, head, or chest).

© Shutterstock

Causes: autoimmune diseases -

Autoimmune diseases can also cause such paralysis. Namely, those that interfere with the communication between nerves and muscles, such as myasthenia gravis (MG).

© Shutterstock

Causes: infections -

Inflammation triggered by infections can also damage vocal cords. These can range from herpes to Lyme disease, Epstein-Barr virus, and even COVID-19, to name a few.

© Shutterstock

Causes: neurological diseases -

Neurological diseases, which can lead to the deterioration and damage of nerves, can also contribute to vocal cord paralysis. Examples include Parkinson’s disease, multiple sclerosis (MS), and stroke.

© Shutterstock

Causes: poisonous substances -

Toxins can be harmful for nerve tissue. These may include poisonous substances such as arsenic, mercury, and lead.

© Shutterstock

Causes: surgery -

Some surgeries can lead to complications and increase the risk of nerve damage to the vocal cords. The use of a breathing tube alone can cause damage.

© Shutterstock

Causes: tumors -

Tumors, both malign (cancerous) and benign, can mess up the vocal cords' nerves. Thyroid cancer and nodules can be particularly harmful.

© Shutterstock

Causes: cold/flu -

Vocal cord paralysis can happen following a simple cold. This is called a post viral or idiopathic paralysis.

© Shutterstock

Diagnosis: imaging tests -

A CT scan or MRI may be prescribed in order to detect any changes of the vocal cords. Most notably, any growths that may be damaging nerves.

© Shutterstock

Diagnosis: laryngoscopy -

This test involves inserting a tube with a camera called a laryngoscope through the nose to analyze the voice box and vocal cords directly.

© Shutterstock

Diagnosis: videostroboscopy -

This exam is similar (and sometimes performed together) to a laryngoscopy. It analyzes how the vocal cords vibrate.

© Shutterstock

Diagnosis: laryngeal electromyography (LEMG) -

This test evaluates the nerve impulses and how they control the muscles in the voice box.

© Shutterstock

Diagnosis: blood tests -

Vocal cord paralysis may also be caused by an infection or an autoimmune disease, so sometimes blood tests are prescribed.

© Shutterstock

Treatment: filler -

Unilateral vocal cord paralysis is usually treated more conservatively than bilateral vocal cord paralysis. Sometimes a filler is injected to close the gap between the vocal cords.

© Shutterstock

Treatment: laryngeal framework surgery -

In some cases, a voice box implant is required. These, usually made of silicon, hold the paralyzed vocal cord in the right place. Medialization laryngoplasty (thyroplasty) is a common procedure.

© Shutterstock

Treatment: reinnervation -

Nerve surgery is sometimes performed in the neck. A nerve is removed from another area and reattached to the vocal cords.

© Shutterstock

Treatment: tracheostomy -

People with bilateral vocal cord paralysis may have to undergo a tracheostomy if breathing becomes too difficult.

Sources: (Cleveland Clinic) (Mayo Clinic)

See also: Aphonia—when you literally lose your voice

© Shutterstock