PATIENT INFORMATION FACT CARD

Vocal Fold Paralysis

The vocal cords or folds are two elastic bands of tissue in the larynx (voice box). They form the entry into the trachea (windpipe). The doctor can see them with a mirror held in the back of your throat. (See Figure 1.) When we breathe, the vocal folds remain apart or open to allow the passage of air. (See Figure 2.) When we laugh, cough, or speak, the folds come together and vibrate. The vocal folds are also important for swallowing. They prevent food from going into the lungs by closing securely when we swallow.

Vocal Fold Paralysis

One or both of the vocal folds can become paralyzed. (See Figure 3.) The most common cause is an injury to the nerve that controls the movement of the muscles in the larynx. This injury may be associated with: Surgery. A tumor in the neck, esophagus, or lung. Brain injury due to a variety of causes, including a stroke or a tumor. Sometimes, the cause is unknown. Figure 3

trachea

Symptoms

vocal cords

paralyzed side

Vocal fold paralysis may cause any or all of the following symptoms: Hoarseness The voice is breathy and weak. The voice may be lost completely. Problems swallowing Patients choke, cough, or both because liquids and food go down the wrong pipe. In severe cases, the choking can lead to shortness of breath or pneumonia. Weak cough Patients are unable to cough up mucous secretions even though they try. Shortness of breath during exercise.

Diagnosis
To make a diagnosis, the doctor looks at your vocal folds with an endoscope. It is a tube with a camera at the end. It is inserted through one of your nostrils and into your throat. The doctor will look at your vocal cords as you repeat some words. If the cause of the paralysis is not known, your doctor may recommend that you get a MRI, a CT scan, or a PET scan. This is done to find out what has caused the paralysis.

Treatment
For some patients, the voice may return without any treatment. The injured vocal fold may recover. In some cases, the uninjured vocal fold may take over for the injured vocal fold. This type of improvement is usually seen within
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the first year or so after damage. If you have problems with swallowing or hoarsness, you may need treatment. Your doctor may recommend any of the treatments described below. Voice therapy uses exercises to strengthen the vocal fold that works. It teaches you how to make up for the injured vocal fold. Injections into the vocal fold may improve the voice and swallowing problems. They may help for a few months until the vocal fold recovers. Surgery to move the vocal folds is another option. This may be helpful for patients who do not improve with the other treatments.

Injection Technique
A vocal fold injection uses synthetic material to add bulk to the vocal fold. This moves the paralyzed fold towards the middle, closer to the normal fold. The injection can be done with a local anesthetic in your doctors office. You will make sounds while the doctor listens to the quality of your voice and looks at your vocal folds using the endoscope. During the injection, you may feel mild discomfort. We will need to monitor you after the injection. You will have to stay in the clinic for about 30 minutes to be sure you have no problems. You may notice an improvement in your voice while the procedure is being done. But, the final result can take weeks. Your voice quality will vary from day to day until that time. Do not eat or drink anything for two hours after the procedure. This allows time for the anesthesia you had to wear off. Avoid screaming and whispering. Both have been shown to irritate your vocal folds.

Surgery
If you have surgery, your paralyzed vocal fold will be moved to the center. This is done under local anesthesia while you are sedated. The surgeon will make an incision on your neck, on the side of the paralyzed vocal fold. He or she then inserts a piece of material to center your vocal fold. This lets the opposite fold come in contact with the paralyzed one. Together, they will produce voice and protect your breathing passage when you swallow. You will stay in the hospital overnight after surgery. There is a small risk of infection and swelling. These can lead to respiratory problems. You will get antibiotics to help lower the risk of infection. Steroids will help reduce swelling. Your doctor and nurse will give you more details if needed.

Call The Doctor Immediately If You Have:

Trouble breathing. Shortness of breath. Noisy breathing. More problems with swallowing. Fever of 100.4 F (38.0 C) or higher.

2004 Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, New York 10021 Revised 2007

Vocal Cord Paralysis

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