Patients with vocal cord paralysis or paresis suffer substantial disability and limitations in their daily lives. More importantly, such patients may not be able to work, especially if their job involves communication. The most common symptoms of vocal cord paralysis or paresis include hoarseness, vocal fatigue, pain for tightness in the throat when speaking, aspiration, and breathing difficulties. The constellation of symptoms may vary depending upon how severely the patient is affected and how well they are able to compensate for the problem.
There are a variety of causes for vocal cord paresis/paralysis. These may include trauma (either in the form of external injury, surgical injury, or intubation), congestive heart failure, viral infection, neuromuscular problems, or cancer or tumor compressing the nerve that controls the vocal cords. Occasionally the cause of vocal cord paresis/paralysis is unknown. One of the most important things to distinguish from vocal cord paresis/paralysis is vocal cord fixation. Fixation of the vocal cords may occur most commonly due to an inflammatory process or previous intubation. On initial examination, vocal cord fixation may appear very similar to vocal cord paresis/paralysis, but may be distinguished either by direct palpation in the operating room or by laryngeal electromyography.
Vocal cord paresis/paralysis is diagnosed by examining the voice box, typically with flexible fiberoptic laryngoscopy. On examination, the physician can see a limitation of movement of one or both vocal cords. Once the clinical diagnosis of vocal cord paresis/paralysis is made, depending upon the circumstances, certain other diagnostic tests may be ordered by the physician. These may include a voice evaluation, stroboscopy, laryngeal electromyography, CT scan, MRI, and/or a swallowing evaluation. Occasionally, the patient may be taken into the operating room to palpate the vocal cords to rule out fixation.
After the work up is complete, treatment is initiated. The timing of treatment depends on the patient's symptoms, vocal requirements, and prognosis. Treatment may include speech therapy, laryngoplasty (with or without arytenoid adduction), laryngeal reinnervation, or injection augmentation. Your physician will discuss these options, and select the best treatment for your individual case.
