Vocal cord paralysis is a condition caused by damage to the nerves that move the vocal cords. We have two vocal cords.
Vocal cord paralysis is a condition caused by damage to the nerves that move the vocal cords. We have two vocal cords. While normal vocal cords perform the functions of breathing and producing sound smoothly, paralyzed vocal cords cannot perform these functions adequately. This can lead to symptoms such as hoarseness, difficulty breathing and difficulty swallowing.
What are the Symptoms of Vocal Cord Paralysis?
The most common symptom of vocal cord paralysis is hoarseness. In addition, difficulty swallowing, difficulty breathing and changes in voice tone can also be observed. Depending on the number of affected vocal cords, paralysis can be unilateral or bilateral.
Depending on the extent of the vocal cord movement problem, patients’ complaints may vary greatly. These symptoms are
Voice Changes: The most common symptom is voice changes. Your voice may become weaker, hoarse or wheezy. In some cases, the voice may disappear completely.
Voice Use Fatigue: You may feel tired when you use your voice intensively, such as speaking or singing for a long time. You may have difficulty raising your voice and shouting.
Swallowing Difficulty: If the structures next to the vocal cords are damaged, you may have difficulty swallowing. This can occur especially when swallowing liquids such as water and tea and can increase the risk of aspiration. Difficulty swallowing manifests itself as a cough and a feeling of something getting into the throat.
Need to Cough or Clear Throat: The paralyzed vocal cord may not be able to close properly, which can lead to an inability to completely close the airway and a cough or a constant need to clear your throat.
Shortness of breath Especially if both vocal cords are affected, the airway may narrow and cause shortness of breath. This is especially noticeable when moving and climbing stairs. Shortness of breath while speaking can be observed in immediate panting.
Sore throat or discomfort: Abnormal tension on the vocal cords can cause pain or discomfort in the throat.
Thinning of the voice: In some cases, while hoarseness improves, the voice is still weak but much thinner. The timbre of the voice changes. In this case, vocal cord paralysis should be considered.
How Do I Know If I Have Vocal Cord Paralysis?
The most obvious symptom of vocal cord paralysis is hoarseness. In addition, difficulty swallowing and difficulty breathing can also be observed. If these symptoms start spontaneously after an operation or suddenly and last for more than 3 weeks, vocal cord paralysis may be suspected.
It is not possible to know whether you have vocal cord paralysis without a detailed examination of your vocal cords. This examination can be performed by an Ear, Nose and Throat physician to determine whether you have vocal cord paralysis.
What Causes Vocal Cord Paralysis?
There are many conditions that cause vocal cord paralysis. If we list these situations;
Surgeries: Especially during surgeries on the neck or chest, the nerves that control our vocal cords can be damaged. This is most common in thyroid surgeries.
Infections: Some diseases, such as influenza, can affect the nerves that can damage our vocal cords.
Masses (tumors): Masses (tumors) that grow in our neck or chest or in our brain can pinch the nerves that control our vocal cords.
Lung Cancer: Lung cancers and cancers and lymphomas involving the lung can damage the vocal cord nerve. This can lead to vocal cord paralysis.
Radiation Therapy (Radiotherapy): Radiation therapy can affect the tissues themselves and the nerves of the vocal cords, especially when it is applied to the neck and chest. Sometimes vocal cord paralysis may occur after the damage.
Accidents and Injuries: Blows to the neck can damage the nerves that control our vocal cords.
Unknown Causes: Sometimes doctors cannot find the cause either. This is called “vocal cord paralysis of unknown cause”. It can start suddenly for no reason.
Medicines: Some medicines can damage our vocal cords as a side effect.
Long Lasting Diseases: Some long-lasting diseases can also damage our vocal cords. Especially rheumatologic diseases are among these.
Heart and Lung Surgeries: The nerves that control our vocal cords can also be damaged during such surgeries.
Nerve Diseases: Some brain and nerve diseases such as MS (Multiple Sclerosis) can also affect our vocal cords.
Which Surgeries are Risky for Vocal Cord Paralysis?
There are some surgeries that carry a risk of vocal cord paralysis. These surgeries carry a risk because they are performed in areas where the nerves that control the vocal cords can be damaged. Here are the main types of surgeries that carry the risk of vocal cord paralysis:
Thyroid Surgeries: The thyroid gland, i.e. the goiter gland, is located in the front part of the neck and the nerves that control the vocal cords can be damaged during surgeries performed here. This can happen especially when it is necessary to remove all or part of the thyroid gland. This risk is especially high in thyroid cancers. This risk will increase even more, especially if you need surgery for the second time.
Parathyroid Surgeries: Parathyroid glands are also located close to the thyroid gland and surgeries in this area may increase the risk of vocal cord paralysis.
Neck Surgery: Any surgical intervention in the neck area can affect the nerves that control the vocal cords.
Carotid artery surgeries: The Vagus nerve, the nerve from which the vocal cord emerges, adheres to the carotid artery. For this reason, surgeries performed on the carotid artery carry a great risk in terms of vocal cord paralysis, especially glomus tumor surgeries and schwannoma surgeries.
Heart Surgeries Especially during open heart surgery, nerves near the rib cage can be damaged.
Pediatric heart surgery: There is a possibility of vocal cord paralysis during PDA closure or open heart surgery in childhood. Since the nerve of the left vocal cord passes in front of the heart, vocal cord paralysis should be considered in hoarseness after these operations.
Thoracic Surgery: Thoracic surgery, i.e. lung surgeries, may increase the risk of vocal cord paralysis. The left vocal cord nerve goes down the neck with the trachea and goes down to the front of the lungs. The risk is particularly pronounced for operations in front of and above the left lung. B
Neurological Surgery: Surgery on areas of the nervous system, such as the brain and spinal cord, can indirectly affect the vocal cords.
Although these surgeries increase the risk of vocal cord paralysis, this risk is not always present and doctors usually plan surgeries to minimize this risk. If you are having this type of surgery, it is important to talk to your doctor about the risks and understand the possible consequences. If hoarseness occurs after these operations, you should consult an ear, nose and throat doctor immediately.
What are the Types of Vocal Cord Paralysis?
Vocal cord paralysis is divided into two main types: unilateral and bilateral. Unilateral vocal cord paralysis usually affects one vocal cord and causes symptoms such as hoarseness. Bilateral vocal cord paralysis affects both vocal cords and can cause more severe breathing difficulties.
What is done in the treatment of unilateral vocal cord paralysis?
Treatment for unilateral vocal cord paralysis can include voice therapy, vocal cord filling or vocal cord implant and vocal cord nerve transfer. These treatments are used to improve the voice in patients suffering from vocal cord paralysis.
What is Vocal Cord Filling?
Vocal cord filling is a medical procedure to improve the function of the vocal cords. It is usually performed in cases such as vocal cord paralysis, vocal cord weakness or vocal cord damage. Here are the main features of vocal cord filling:
Purpose: It is a procedure to narrow the space between the vocal cords and to make the vocal cords closer together. In this way, the vocal cords can vibrate better and produce a clearer sound.
How it is done: This procedure is usually performed under local anesthesia, i.e. without surgery, so that the patient is awake but does not feel pain. The doctor injects filler into one or both vocal cords with a thin needle. The procedure takes 15-20 minutes and the patient can resume his/her life immediately. Hospitalization is not required.
Filling Materials: Various materials can be used as fillers. These materials can be temporary or long-acting. Temporary fillers are usually made of naturally occurring substances in the body such as hyaluronic acid. It is similar to the substances used in lip fillers. Long-acting fillers are usually made of synthetic materials. They are used in special cases
Effects: Vocal cord filling can help to strengthen the voice, help to speak with less effort and improve voice quality. It can also make swallowing easier in some patients.
Risks and Side Effects: Like any medical procedure, vocal cord filling involves some risks. Problems such as infection at the injection site, reactions or displacement of the filling material may occur. However, this procedure is generally safe and serious complications are rare.
Recovery Process: After the procedure, patients usually undergo a rapid recovery process. It may take a few days for the voice to fully recover and return to the desired level.
What is a Vocal Cord Implant?
A vocal cord implant is a treatment method used to improve the voice in patients suffering from vocal cord paralysis. In this method, a small implant is placed between the vocal cords. This implant allows the vocal cords to be in a closer position, helping the voice to sound clearer. The vocal cord implant is usually performed under semi-general anesthesia (sedation) and is an effective and lifelong option for treating vocal cord paralysis.
1. Purpose: The vocal cord implant is usually used in patients with unilateral vocal cord paralysis. Its purpose is to permanently fatten the paralyzed vocal cord so that it can close better with the intact vocal cord and thus produce a clearer voice.
How it is done: This procedure is usually performed under sedation anesthesia, meaning that the patient is put to sleep. Through a small incision in the neck, the surgeon reaches behind the vocal cords and places the implant. It is a similar surgery to a breast implant. The implant allows the vocal cords to be closer, helping to produce better sound. During the procedure, the patient is made to talk and it is tried to understand whether the voice has improved sufficiently, so that the ideal implant is placed.
Implant Materials: Implants are usually made of non-melting materials compatible with the body called silicone, gortex. These materials are not rejected by the body and offer a permanent solution.
Effects: A vocal cord implant can help to strengthen the voice, help to speak with less effort and improve voice quality. It can also make swallowing easier in some patients.
Risks and Side Effects: Like any surgical procedure, a vocal cord implant involves risks related to infection, bleeding and anesthesia. In addition, complications such as dislocation or rejection of the implant by the body may occur. These risks are very rare. There is no risk of loss of voice.
Healing Process: The healing process usually takes a few weeks. During this period, it is important that patients do not overuse their voices and follow the doctor’s recommendations.
What is vocal cord nerve transportation surgery (laryngeal reinnervation)?
Vocal cord nerve transfer surgery, also known as vocal cord nerve transplantation, is a surgical procedure used when the nerves that control the vocal cords are damaged. This surgery is performed to improve the voice and partially or completely restore vocal cord function, especially in cases of vocal cord paralysis. Here are the main features of this surgery:
Purpose: The main purpose of the surgery is to replace or connect the damaged or dysfunctional vocal cord nerves with another intact nerve. This helps to restore the function of the vocal cord movements and thus contributes to the recovery of the voice. During this procedure, no foreign material is inserted into the body, the body heals with its own tissue.
How it is done: The surgeon removes another nerve, usually from one area of the neck, and connects it to the damaged vocal cord nerve. This is usually done under general anesthesia, which means that the patient is put to sleep. The nerve that is removed is usually the nerve from one of the small muscles on the same side of the neck, and this nerve is rerouted to revitalize the vocal cord.
Which nerves are used? Usually the nerve of one of the muscles in the neck that help swallowing is used. These nerves have the potential to move the vocal cords effectively. There is no loss of function in these muscles due to the use of these nerves.
Effects: Successful nerve transfer surgery can help strengthen and better control the voice. Patients can see significant improvements in voice quality and speaking ability.
Risks and Side Effects: As with any surgical procedure, there are risks associated with infection, bleeding and anesthesia. In addition, it may take time for the nerve to adapt and function in its new location after the nerve transfer procedure.
Recovery: The recovery period usually ranges from a few weeks to a few months. During this process, it is important to follow the doctor’s recommendations.
What are the Treatment Methods for Bilateral Vocal Cord Paralysis?
In case of bilateral vocal cord paralysis, methods such as laser breath expansion surgery or vocal cord nerve transport surgery (laryngeal reinnervation) can be applied. Laser breath expansion surgery offers a solution to shortness of breath in patients with bilateral vocal cord paralysis. This surgery aims to improve the movement of the vocal cords and increase the patient’s ability to breathe. Common treatment options include:
Voice Therapy: Involves working with a speech-language pathologist to improve voice quality and strength. Techniques such as breathing support exercises, vocal cord strengthening exercises and strategies to keep the airway open during speech can be used.
Laser Breath Expansion Surgery
Laser breath expansion surgery offers a solution to shortness of breath in patients with bilateral vocal cord paralysis. This surgery aims to improve the movement of the vocal cords and increase the patient’s ability to breathe. During the surgery, a portion of the vocal cords is removed using a laser. This allows the vocal cords to move more and thus breathe better. The surgery is performed through the mouth and has an immediate effect on breathing.
Botulinum Toxin (Botox) Injections: Used in some cases, especially to treat partial vocal cord paralysis or in the early stages when recovery is expected.
Bilateral vocal cord nerve transplantation – Bilateral Selective Reinnervation: This is a newer surgical technique that aims to restore tone to the vocal cords and nerve function to the muscles. It is performed in very few centers in the world. It was performed for the first time in Turkey by Dr. Necati Enver. It is the only treatment method that allows the vocal cords to move and can improve both breathing and voice.
Tracheostomy: It is a treatment method that can be used especially in emergencies, when breathing is difficult. A tracheostomy bypasses the vocal cords and creates a direct airway in the windpipe.
The choice of treatment depends on the cause of the paralysis, the patient’s general health, vocal demands and the presence of other medical conditions.
Is There a Non-Surgical Treatment for Vocal Cord Paralysis?
Yes, there are treatments for vocal cord paralysis, such as voice therapy and non-surgical vocal cord filling. Voice therapy plays an important role in treating vocal cord paralysis and helps patients to improve their voice. Non-surgical vocal cord filling is a method used to add volume to the vocal cords and is usually performed under local anesthesia.
Voice Therapy in Vocal Cord Paralysis
Voice therapy plays an important role in treating vocal cord paralysis and helps patients to improve their voice. Voice therapy teaches patients to use their vocal cords more effectively and helps to strengthen their voice. This therapy is usually conducted by a speech therapist and includes various exercises and techniques to improve the voices of patients with vocal cord paralysis.
The ideal patients for whom voice therapy is effective are vocal cord paralysis patients with mild hoarseness or patients who have had vocal cord fillers-implants and need support.
Here are some key points that explain the role of voice therapy:
Improving Voice Quality: Voice therapy offers exercises designed to make the voice clearer and more intelligible. This aims to make the best use of the available capacity of the vocal cords.
Breath Control: Breath control is vital for voice production. Therapy enables patients to use their breath more effectively and learn correct breathing techniques when speaking.
Increasing Voice Power: People with vocal cord paralysis often find it difficult to raise their voices. Voice therapy offers techniques to increase the power and projection of the voice.
Improving Comfort During Speech: Therapy teaches techniques to help patients feel less tired and more comfortable when speaking.
Voice Hygiene: Vocal hygiene is important to maintain vocal health. Therapists provide training on how to protect the voice and avoid habits that can damage the vocal cords.
Individualized Treatment Plans: Every patient is different and voice therapy is tailored to the specific needs of the individual. The therapist develops a treatment plan tailored to the patient’s condition and goals.
Psychological Support and Motivation: Vocal cord paralysis can affect the way a person expresses themselves, which can lead to stress or anxiety. Voice therapists provide support during this challenging process, helping to increase patients’ motivation and self-confidence.
Continuous Assessment and Follow-up: Throughout the treatment process, the patient’s progress is continuously assessed and the therapy plan is updated if necessary.
Non-Surgical Vocal Cord Filling in Vocal Cord Paralysis
Non-surgical vocal cord filling is a method used to treat vocal cord paralysis and is usually performed under local anesthesia. This method is used to add volume to the vocal cords and helps relieve symptoms such as hoarseness. Vocal cord filling helps the vocal cords to be in a closer position, helping the voice to sound clearer.
Conclusion
It is important to be aware of vocal cord paralysis, vocal cord paralysis diagnosis and treatment methods. Imaging methods such as computed tomography can help in the diagnosis of vocal cord paralysis. Treatment of vocal cord paralysis depends on the patient’s condition and the type of paralysis. Vocal cord paralysis is a manageable condition with effective treatment methods and can improve patients’ voices and breathing abilities.