Vocal Cord Paralysis
When the recurrent laryngeal nerve is injured, the vocal fold may be paralyzed. In this situation it does not move at all. A vocal fold paralysis on one side usually leads to significant voice problems and sometimes trouble swallowing liquids. This is because the vocal folds can not close completely, leaving a gap between them. When both vocal folds are paralyzed, breathing is a major concern, since the vocal folds can not open adequately to allow comfortable breathing. A tracheotomy (breathing tube in the neck) may be necessary when both vocal folds are paralyzed.
The most common cause of unilateral vocal fold paralysis is surgery. Because the recurrent laryngeal nerve has a long course through the neck and chest, it is vulnerable to injury from many types of surgeries, particularly thyroid surgery, chest and esophageal surgery, and cervical spine surgeries. Tumors located anywhere along the course of the recurrent laryngeal nerve may also cause vocal fold paralysis, so your surgeon may order imaging studies to rule out lung cancer or other types of cancers. Other causes of vocal fold paralysis include viral infections and trauma. Sometimes the cause of the vocal fold paralysis can not be determined.
Nerve injury is not the only cause of vocal fold immobility. Trauma can disrupt the joint of the vocal fold, causing fixation of the vocal fold. Laryngeal electromyography (LEMG) can be used to measure the nerve activity to the vocal folds. This allows your surgeon to determine if the vocal fold is paralyzed (nerve injury) or fixated (joint injury). LEMG also gives information about the potential for a nerve injury to recover on its own.
A weakness of the vocal fold (paresis) without total paralysis is a much more common scenario, with the most common cause being viral infections. Often both vocal folds are affected. LEMG is particularly useful in making this diagnosis, in combination with the laryngeal examination and speech pathology evaluation. The treatments for vocal fold paresis are similar to the treatments for vocal fold paralysis.
All treatments for vocal fold movement problems involve reducing the gap between the vocal folds during voice production and swallow. Available treatments at the Center for Voice and Swallowing Disorders include: medialization laryngoplasty, arytenoid adduction, vocal fold injection augmentations in the operating room, and in-office vocal fold injections.