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vocal cord paralysis
Paralysis of one or both of the vocal cords (or vocal folds).
Etiology:
1) head trauma
2) stroke
3) Parkinson's disease
4) multiple sclerosis
5) neck injury
6) malignancy
a) lung cancer
b) thyroid cancer
c) tumor pressing on recurrent laryngeal nerve
7) viral infection
8) idiopathic
Epidemiology:
- common, especially in elderly (see etiology)
Pathology:
1) aspiration common
2) dyspnea if both cords affected (rare) (air passage to the trachea blocked)
Clinical manifestations:
1) symptoms can range from mild to life threatening
2) dysphagia
3) cough
4) voice changes, changes in voice quality
- discomfort from vocal straining
5) if only one vocal cord is damaged
a) voice is usually hoarse or breathy
b) changes in voice quality, loss of volume or pitch
6) damage to both vocal cords (rare) generally causes dyspnea
Special laboratory:
1) endoscopy
2) acoustic spectrography by speech pathology
3) laryngeal electromyography (NGC)
Management:
1) surgery
a) often delayed (1 year) to see if spontaneous resolution will occur
b) involves adding bulk to the paralyzed vocal cord or changing its position
1] bulking agents injected into paralyzed vocal cord
a] Teflon, collagen, silicone, or body fat used
b] added bulk reduces the space between the vocal cords so the nonparalyzed cord can make closer contact with the paralyzed cord & thus improve the voice
2] permanently shifting a paralyzed cord closer to the center of the airway may improve the voice
-> allows the nonparalyzed cord to make better contact with the paralyzed cord
c) can improve both voice & swallowing
d) tracheostomy if both vocal cords paralyzed
2) voice therapy (speech pathology)
Prognosis:
- in some cases, the voice returns without treatment during the first year after damage
Related
vocal cord/fold/shelf (Ferrein cords, true vocal cord)
General
laryngoplegia; laryngeal paralysis
vocal cord dysfunction; inducible laryngeal obstruction
References
- Vocal Cord Paralysis
http://www.nidcd.nih.gov/health/voice/vocalparal.asp