Bilateral vocal fold paralysis is a disorder characterized by complete immobility of both vocal folds. This can be a potentially life threatening condition if the vocal folds are paralyzed in the paramedian position (nearly closed), producing an airway obstruction. In other cases, the vocal folds may be paralyzed in a more open position, resulting in significant voice change.

Bilateral Vocal Fold Paralysis

Bilateral Vocal Fold Paralysis Causes 

Causes of bilateral vocal fold paralysis may include physical injury to the nerve that gives the vocal fold motion (ie surgical trauma), prolonged endotracheal intubation, neurologic conditions, or idiopathic (unknown) origins.

Bilateral Vocal Fold Paralysis Symptoms, Signs, Diagnosis 

Symptoms of bilateral vocal fold paralysis are highly variable depending on the position of the paralyzed vocal folds. For example, if the vocal folds are fixed in the paramedian (almost closed position), patients often have a normal voice, but may present with inspiratory stridor, and in some cases, respiratory failure due to airway obstruction. If the vocal folds are fixed in a more open position, the airway may be preserved, but the patient may experience a severely breathy, weak voice or complete voice loss.

Bilateral Vocal Fold Paralysis Treatment 

If there is no emergent need (the patient’s airway is not obstructed by the vocal fold paralysis), a “wait and see” approach may be recommended, usually for a period of up to six months.

In cases where airway obstruction is of concern, more drastic and emergency measures may be required, such as tracheostomy. Other options for airway restoration may include arytenoidectomy (removal of the arytenoid cartilages) or transverse cordotomy (removal of the posterior portion of the vocal fold). Surgical vocal fold lateralization is an additional treatment option to permanently widen the entrance into the airway.