Vocal Cord Paralysis

Vocal Cord paralysis is either idiopathic (cause unknown) or iatrogenic (cause by medical interventions or operations), or is posttraumatic (after an injury or blow to the neck).

Idiopathic Vocal Cord Paralysis

Idiopathic vocal cord paralysis usually follows a viral upper respiratory tract infection. It is thought that patients develop a viral inflammation of nerve or nerves that move the vocal folds. This results in a weak breathy voice. It is important if this happens to see an ENT surgeon to rule out any more significant or serious causes of the loss of voice.

Most cases of idiopathic vocal cord paralysis recover but recovery time can last from weeks to years. In people who need their voice to work a variety of simple surgical interventions are available, the most common being paraumbilical liposuction and autologous fat augmentation of the vocal folds. This involves a minor surgical procedure where a small cut is made near the belly button; fat is sucked out and injected to bulk out the paralyzed or immobilized vocal cord. This makes it easier for the normal, or mobile vocal cord to oppose it and restore normal voice. If and when the paralyzed vocal cord starts moving again, the fat is distributed with no harmful effects.

Iatrogenic Vocal Cord Paralysis

Iatrogenic vocal fold paralysis most commonly follows thyroid surgery. It can be temporary or permanent, unilateral (one-sided) or bilateral (both sides). If one vocal fold is paralyzed, due to stretching, revascularization (interruption to blood supply), or cutting to the nerve, again voice can be restored to by a simple surgical procedure as alluded to above. This can be done immediately after the operation, so that the chance of hoarseness and duration of loss of voice is minimised.

Bilateral Vocal Cord paralysis poses a different problem. When we breathe the vocal cords move apart and when we talk they move together. If this movement is impaired, depending on where the vocal cord is paralyzed, there may be a restriction of airway with resultant shortness of breath. If this is the case, then the laser procedure called laser tenotomy of the vocal folds can be undertaken to make a small wedge incision in the back of the vocal folds to open the airway.

Posttraumatic Vocal Cord Paralysis

It is nearly always associated with a severe blow to the neck. The most common causes of this are motor vehicle accidents and/or direct trauma. They are often associated with fractures of the cartilaginous framework of the voice box. If they occur, they tend to be permanent.

Appropriate surgical intervention, to place the vocal cord in the optimal position for talking and breathing, should be undertaken at the time of primary repair of the fractures of the voice box.