Everyone has two vocal cords in his or her larynx (voicebox). The vocal cords vibrate during speech to produce voice. If one or both vocal cords are unable to move then the person will experience voice problems and possibly breathing and swallowing problems. This is vocal cord paralysis.
There are different types of vocal cord paralysis. Bilateral vocal cord paralysis involves both vocal cords becoming stuck halfway between open and closed (the paramedian position) and not moving either way. This condition often requires a tracheotomy (an opening made in the neck to provide an airway) to protect the airway when the person eats.
Unilateral vocal cord paralysis is when only one side is paralyzed in the paramedian position or has a very limited movement. It is more common than bilateral involvement. The paralyzed vocal cord does not move to vibrate with the other cord but vibrates abnormally or does not vibrate at all. The individual will run out of air easily. They will be unable to speak clearly or loudly.
Signs and symptoms
The severity of voice and swallowing problems depends on where the nerve damage occurs. Typical symptoms include:
- breathy voice
- inability to speak loudly
- limited pitch and loudness variations
- voicing that lasts only for a very short time (around 1 second)
- choking or coughing while eating
- possible pneumonia due to food and liquid being aspirated into the lungs (the vocal cords cannot close adequately to protect the airway while swallowing)
The vocal cords can be examined by using an endoscope that is inserted through the nose or mouth. An endoscope has a light that the examiner uses to view the cords and movement patterns during phonation (producing sound) and at rest. Typically a complete voice evaluation is conducted by a speech-language pathologist (SLP) and otolaryngologist (ear, nose, and throat doctor).
Bilateral paralysis is often medically treated and may require a tracheotomy to allow the person to eat safely. Surgery may be considered to bring one or both vocal cords closer to midline.
Unilateral paralysis can be treated medically and/or behaviorally. Medical treatment includes muscle-nerve transplant, medialization thyroplasty (moving the paralyzed vocal cord toward midline), or injection of a substance to increase the size of the paralyzed vocal cord.
Behavioral treatment includes voice therapy by an SLP. It may be the only treatment required for the individual. The individual will work with the SLP on pitch alteration, increasing breath support and loudness, and finding the correct position for optimal voicing (such as turning the head to one side or manipulating the thyroid cartilage). Research has shown that voice therapy is an effective intervention in the interim period between diagnosis of the paralysis and final resolution of the problem.
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