What Is Vocal Cord Paralysis? How a Throat Specialist Can Help

Your vocal cords play an important role in speaking, breathing and swallowing. When one or both vocal cords cannot move properly due to nerve damage or dysfunction, it is known as vocal cord paralysis. This can cause hoarseness, a weak voice, swallowing difficulties and, in some cases, breathing problems. Appropriate treatment depends on the underlying cause and may include voice therapy, medication or surgery.

Key Takeaways

• Vocal cord paralysis occurs when one or both vocal cords cannot move properly due to nerve damage or dysfunction.
• Symptoms include hoarseness, breathy voice, swallowing difficulty and choking.
• Causes include surgery, infections, neurological conditions or may be unknown.

What Is Vocal Cord Paralysis?

Vocal cord paralysis occurs when the nerves controlling the vocal cords are damaged or stop working properly, preventing one or both vocal cords from opening and closing normally. This can affect voice quality, swallowing and, in some cases, breathing.

The severity of symptoms depends on whether one or both vocal cords are affected and the underlying cause.

Unilateral vs Bilateral Vocal Cord Paralysis

There are two main types of vocal cord paralysis: unilateral, which affects one vocal cord and is more common, and the less common bilateral, which affects both cords.

Why Normal Vocal Cord Movement Matters

Healthy vocal cords perform several essential functions:

• Produce a clear, strong voice
• Protect the airway during swallowing
• Allow normal breathing
• Help generate an effective cough to clear the airway

Impaired vocal cord movement can affect communication, swallowing and breathing.

What Are the Possible Causes of Vocal Cord Paralysis?

This condition has a range of potential root causes including injury, disease or pressure on the nerves. In some cases, the exact cause cannot be identified despite thorough investigation.

Surgery

Surgery involving the thyroid, cervical spine, carotid arteries, oesophagus or heart can occasionally injure or stretch the recurrent laryngeal nerve, resulting in vocal cord paralysis. This is one of the most common causes of vocal cord paralysis.

Viral Infections

Viral infections may temporarily inflame the nerves controlling the vocal cords. Recovery may occur gradually over several months.

Neurological Conditions

Conditions affecting the brain or nervous system can interfere with control over vocal cord movement.

Examples include:

• Stroke
• Parkinson's disease
• Multiple sclerosis
• Motor neurone disease
• Brain or spinal cord disorders

Tumours

Growths in the neck or chest such as thyroid and lung tumours, oesophageal cancers and other masses located near the recurrent laryngeal nerve may compress the nerves supplying the vocal cords.

Trauma

Trauma from accidents, prolonged intubation or medical procedures involving the airway can occasionally damage the nerves that control the vocal cords.

Idiopathic Vocal Cord Paralysis

In some patients, no identifiable cause is found despite appropriate investigations. Viral nerve inflammation is thought to account for some cases.

What Are the Symptoms of Vocal Cord Paralysis?

Symptoms depend on whether one or both vocal cords are affected and may involve voice, swallowing or breathing problems.

Voice Changes

Common symptoms include:

• Hoarseness
• Breathy or weak voice
• Reduced volume
• Vocal fatigue

Swallowing Problems

Symptoms include:

• Choking while eating or drinking
• Frequent coughing during meals
• Sensation of food "going down the wrong way"
• Recurrent chest infections in severe cases

Breathing Difficulties

Breathing issues are more common in bilateral paralysis.

Symptoms include:

• Noisy breathing (stridor)
• Shortness of breath
• Difficulty breathing at rest

Breathing difficulty, especially noisy breathing or shortness of breath at rest, requires prompt medical assessment because bilateral vocal cord paralysis can narrow the airway.

How Is Vocal Cord Paralysis Treated?

Treatment depends on the underlying cause, whether one or both vocal cords are affected, the severity of symptoms and the likelihood of nerve recovery. The goals of treatment are to improve voice quality, protect swallowing and maintain safe breathing.

Treatment may include:

• Voice therapy to improve vocal strength and control
• Vocal cord injection to improve closure of the vocal cords
• Medialisation thyroplasty to reposition the affected vocal cord
• Reinnervation surgery to restore nerve function
• Treatment of the underlying cause where possible

Consulting a throat specialist can assess the underlying cause and recommend the most appropriate treatment plan based on your symptoms and overall health.

Recovery depends largely on the underlying cause and the extent of nerve injury. Some patients recover naturally over several months, particularly when paralysis is caused by temporary nerve inflammation or stretching. Others may require procedures or surgery to improve voice function. Even when full recovery does not occur, many patients experience meaningful improvements in voice, swallowing or breathing with appropriate treatment and rehabilitation.