Vocal Paralysis

What is Vocal Paralysis?

Vocal paralysis is the total absence of movement of a vocal cord due to nerve damage. A paralysis may be partial, in which case it is called a paresis. A paresis is due to partial nerve injury.

Each vocal cord has two nerves that are associated with it. These two nerves are responsible for making the muscles of the vocal cord move. The nerves are called the superior laryngeal nerve and the recurrent laryngeal nerve. The nerves may become damaged through a variety of mechanisms. When the nerve is injured, the muscles are unable to move and therefore the vocal cord does not move.

What kind of surgery can result in nerve injury?

The most common surgeries that affect the laryngeal nerves include:

• Thyroidectomy (partial or total)
• Neck dissection
• Carotid surgery
• Spinal surgery (with a neck incision)
• Heart surgery
• Mediastinoscopy
• Mediastinal mass (thymoma, lymph nodes, etc)
• Long surgery of any kind (due to a long period of breathing tube placement)
• Esophageal surgery

Vocal Paralysis Symptoms

The symptoms of a vocal paralysis vary according to the severity of the weakness. A paresis will have more subtle symptoms than a paralysis. Symptoms are listed according to severity (least to most):

• Vocal fatigue
• Reduced vocal range (usually loss of top notes)
• Effortful speech
• Breathy voice (sound of air escaping while speaking)
• Shortness of breath
• Inability to cough/throat clear
• Aspiration (food and drink going down the wrong pipe)

What does vocal paralysis look like on an exam?

When the vocal cord is paralyzed, it doesn’t move. When it is partially paralyzed (paretic) it moves less briskly. There will usually be a gap between the vocal cords as well, because the paralyzed cord is not able to move to the middle and touch the normal cord.

How do I know if I have vocal paralysis?

The only way to know if your symptoms are due to a paralysis is to have your vocal cords examined. This requires the use of videostroboscopy or flexible laryngoscopy by a laryngologist.

Vocal Paralysis Complications

Are there possible complications of a paralysis?

There are potential complications of paralysis, particularly when the paralysis is total. Complications include:

• Hoarseness
• Aspiration (food and drink going into the airway) with resultant pneumonia and lung infections
• Chronic cough

How can I avoid having a complication?

Early diagnosis is the key to avoiding these complications. This means coming in for evaluation as soon as you are hoarse or if you have any voice or swallowing changes after surgery.

Truths & Myths

I hear so many conflicting things about paralysis? What is the truth?

Myth: Vocal paralysis never recovers.

Truth: The likelihood of recovery depends on the cause of the paralysis.  However the most common causes are likely to recover.

Myth: Paralysis requires surgery.

Truth: Most often, paralysis does not require any surgery. However, many of the symptoms of paralysis are disabling (hoarseness, difficulty swallowing, etc) and a procedure may limit your symptoms. This procedure is short, ambulatory, and painless and can result in significant improvement while you wait for your paralysis to recover.

Myth: Paralysis is not preventable

Truth:  In most cases, paralysis is not preventable. However, for those who are about to undergo neck, chest or spine surgery, choosing the right surgeon can dramatically decrease your risk. If you are having neck, chest, or spine surgery, you should look for a surgeon who is aware of the risks to your voice. This often means they will take extra precautions before, during, and after surgery to protect your voice.

Unfortunately, this is hard to find. Look for a surgeon who is affiliated with a voice surgeon/laryngologist and see the laryngologist before surgery. Often, having someone to consult if you have a problem will limit the symptoms and complications you have.

Vocal Paralysis Treatment

Treatment is most effective when a paralysis is detected early.

This may seem simple, but without videostroboscopy it is much more difficult.

How do you handle vocal paralysis?

Vocal paralysis treatment depends largely on the cause. Depending on the cause, most people can benefit from one of several simple procedures to alleviate symptoms. Unlike at other institutions, we do not necessarily wait to see if a patient will get better. This is because, during a waiting period, the patient can suffer significant complications and be unable to work due to voice loss. Specialized techniques developed here at the Osborne Head and Neck Institute are used to limit disability due to vocal paralysis. Waiting is reserved for patients who would prefer it or for those who have a significant reason to avoid a procedure.

Medications and vocal hygiene are also utilized to optimize recovery.

At the Division of Voice and Laryngology at Osborne Head and Neck Institute (OHNI), we understand that your voice is your livelihood. We take the utmost care to prevent poor voice outcomes. Your evaluation at OHNI includes:

• A complete history
• A complete physical exam of the head and neck
• Laryngoscopy
• Videostroboscopy
• Treatment planning – this usually includes voice therapy with a skilled therapist, trained in the treatment of voice disorders

This comprehensive evaluation results in the best treatment plan for you, that will help prevent you from having future problems.

Can I just see my regular ENT doctor?

Unfortunately, few people are trained to correctly diagnose and treat voice disorders. Only a laryngologist can accurately diagnose and treat you, and help prevent you from having a worse problem.

What should I ask my doctor when I see him/her to ensure I’m getting the right treatment?

You should ask your voice physician the following questions to ensure you are getting the treatment you deserve:

1. Are you board certified in ENT?

2. Are you fellowship-trained in laryngology/professional voice?

3. Do you perform videostroboscopy?

4. Do you perform the examination on your patients?*

5. When surgery is needed, do you perform the surgery yourself or are there other doctors or doctors-in-training involved?*

6. Do you accept insurance? Are your services covered by insurance?

*Often, laryngologists are located in facilities where residents or fellows (doctors-in-training) perform a large portion of the services.

Does insurance pay for a laryngologist visit?

If the laryngologist accepts insurance, your visit is usually covered. Laryngoscopy with stroboscopy is also usually covered. It is best to ask your doctor’s office billers to clarify insurance issues.