Table of Contents
Vocal Cord Paralysis
Treatment Details
Vocal cord paralysis is a condition that occurs due to damage to the nerves that move the vocal cords. We have two vocal cords.
Vocal cord paralysis is a condition that occurs due to damage to the nerves that move the vocal cords. We have two vocal cords. While normal vocal cords perform the functions of breathing and voice production smoothly, paralyzed vocal cords cannot adequately perform these functions. This condition can lead to symptoms such as hoarseness, difficulty breathing, and difficulty swallowing.
What Are the Symptoms of Vocal Cord Paralysis?
Among the most common symptoms of vocal cord paralysis is hoarseness. Additionally, difficulty swallowing, shortness of breath, and changes in voice tone may be observed. Depending on the number of affected vocal cords, paralysis can be unilateral or bilateral.
Depending on the extent of the vocal cord mobility problem, patients’ complaints can vary significantly. These symptoms include:
Voice Changes: The most common symptom is voice changes. Your voice may be weaker, hoarse, or breathy. In some cases, the voice may be completely lost.
Vocal Fatigue: You may experience fatigue when using your voice intensively, such as during prolonged speaking or singing. You may find it difficult to raise your voice or shout.
Difficulty Swallowing (Dysphagia): Difficulty swallowing may occur if structures located near the vocal cords are damaged. This can manifest especially when swallowing liquids such as water or tea, and it may increase the risk of aspiration. Difficulty swallowing presents itself as coughing or the sensation of something being caught in the throat.
Coughing or Throat Clearing Sensation: A paralyzed vocal cord may not close properly, leading to an inability to completely close the airway and a sensation of coughing or needing to constantly clear your throat.
Shortness of Breath: Especially if both vocal cords are affected, the airway can narrow, leading to shortness of breath. This condition is more noticeable during physical activity, such as climbing stairs. Running out of breath quickly while speaking can also be observed.
Throat Pain or Discomfort: Abnormal tension on the vocal cords can cause a sensation of pain or discomfort in the throat.
Thinning of the Voice: In some cases, as hoarseness improves, the voice may still be weak but much higher-pitched. The timbre of the voice changes. In such instances, vocal cord paralysis should also be considered.
How Do I Know If I Have Vocal Cord Paralysis?
The most prominent symptom of vocal cord paralysis is hoarseness. Additionally, difficulty swallowing and difficulty breathing may be observed. If these symptoms begin suddenly after surgery or spontaneously, and persist for longer than 3 weeks, vocal cord paralysis may be suspected.
It is not possible to determine if you have vocal cord paralysis without a detailed examination of your vocal cords. This examination can be performed by an Ear, Nose, and Throat (ENT) specialist to diagnose vocal cord paralysis.
What Causes Vocal Cord Paralysis?
There are many conditions that can cause vocal cord paralysis. These include:
Surgeries: During surgeries, especially those performed on the neck or chest, the nerves controlling our vocal cords can be damaged. This is most commonly seen in thyroid surgeries.
Infections: Certain illnesses, such as the flu, can affect the nerves that control our vocal cords, potentially damaging them.
Masses (Tumors): Masses (tumors) growing in our neck, chest, or brain can compress the nerves that control our vocal cords.
Lung Cancer: In lung cancers and lymphomas affecting the lungs, the vocal cord nerve can be damaged, leading to vocal cord paralysis.
Radiation Therapy (Radiotherapy): Radiation therapy, especially when applied to the neck and chest, can affect the tissues themselves and the nerves of the vocal cords. Sometimes, vocal cord paralysis can occur as a result of the damage it causes.
Accidents and Injuries: Blows to the neck can damage the nerves that control our vocal cords.
Unknown Causes: Sometimes doctors cannot find the cause. This is called “idiopathic vocal cord paralysis.” It can begin suddenly without a known reason.
Medications: Some medications can damage our vocal cords as a side effect.
Chronic Diseases: Some long-standing diseases can also damage our vocal cords. Rheumatological diseases are particularly among these.
Heart and Lung Surgeries: During these types of surgeries, the nerves controlling our vocal cords can also be damaged.
Neurological Diseases: Certain brain and nerve diseases, such as MS (Multiple Sclerosis), can also affect our vocal cords.
Which Surgeries Carry a Risk of Vocal Cord Paralysis?
There are certain surgeries that carry a risk of vocal cord paralysis. These surgeries are risky because they are performed in areas where the nerves controlling the vocal cords can be damaged. Here are the main types of surgeries that carry a risk of vocal cord paralysis:
Thyroid Surgeries: The thyroid gland, or goiter gland, is located in the front of the neck, and during surgeries performed here, the nerves controlling the vocal cords can be damaged. This can particularly happen when all or part of the thyroid gland needs to be removed. This risk is especially high in thyroid cancers. The risk further increases if you need to undergo surgery for the second time.
Parathyroid Surgeries: The parathyroid glands are also located near the thyroid gland, and surgeries performed in this region can increase the risk of vocal cord paralysis.
Neck Surgery: Any surgical intervention in the neck region can affect the nerves controlling the vocal cords. This risk exists in all surgeries performed throughout the neck.
Carotid Artery Surgeries: The Vagus nerve, which is the nerve from which the vocal cord nerve originates, runs adjacent to the carotid artery. Therefore, surgeries targeting the carotid artery, such as glomus tumor surgeries and schwannoma surgeries, carry a significant risk of vocal cord paralysis.
Heart Surgeries: Especially during open-heart surgeries, nerves near the rib cage can be damaged.
Pediatric Cardiac Surgeries: There is a possibility of vocal cord paralysis during PDA closure or open-heart surgeries in childhood. Since the nerve of the left vocal cord passes in front of the heart, vocal cord paralysis should be considered in cases of hoarseness after these surgeries.
Thoracic Surgery: Thoracic surgery, meaning lung surgeries, can increase the risk of vocal cord paralysis. The left vocal cord nerve descends from the neck along with the trachea and extends to the front of the lungs. The risk is particularly pronounced for surgeries on the front and upper parts of the left lung.
Neurological Surgery: Surgeries performed 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 generally plan surgeries to minimize this risk. If you are undergoing such a surgery, it is important to discuss the risks with your doctor and understand the potential outcomes. If hoarseness occurs after these surgeries, an ENT doctor should be consulted without delay.
What Are the Types of Vocal Cord Paralysis?
Vocal cord paralysis is divided into two main types: unilateral and bilateral. Unilateral vocal cord paralysis typically affects one vocal cord and leads to symptoms such as hoarseness. Bilateral vocal cord paralysis, on the other hand, affects both vocal cords and can cause more severe breathing difficulties.
What Are the Treatments for Unilateral Vocal Cord Paralysis?
Treatment for unilateral vocal cord paralysis can involve methods such as voice therapy, vocal cord injection 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 Injection?
Vocal cord injection is a medical procedure performed to improve the function of the vocal cords. It is typically applied in conditions such as vocal cord paralysis, vocal cord weakness, or vocal cord damage. Here are the key features of vocal cord injection:
Purpose: It is a procedure performed to narrow the gap between the vocal cords and bring them closer together. This allows the vocal cords to vibrate better and produce a clearer voice.
How It’s Performed: This procedure is usually performed under local anesthesia, meaning the patient is awake but will not feel pain. The doctor injects a filler substance into one or both vocal cords with a fine needle. The procedure takes about 15-20 minutes, and the patient can immediately resume their daily life. Hospitalization is not required.
Filler Materials: Various materials can be used as fillers. These materials can be temporary or long-lasting. Temporary fillers are usually made from naturally occurring substances in the body, such as hyaluronic acid. They are similar to the substances used in lip fillers. Long-lasting fillers are generally made from synthetic materials and are used in special cases.
Effects: Vocal cord injection can help strengthen the voice, reduce effort during speech, and improve voice quality. It can also facilitate swallowing in some patients.
Risks and Side Effects: Like any medical procedure, vocal cord injection carries some risks. Problems such as infection at the injection site, reactions, or displacement of the filler material may occur. However, this procedure is generally safe, and serious complications are rare.
Recovery Process: After the procedure, patients generally experience a rapid recovery. It may take a few days for the voice to fully recover and reach 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 helps the vocal cords to be in a closer position, allowing for a clearer voice. Vocal cord implantation is usually performed under semi-general anesthesia (sedation) and is an effective and lifelong permanent option for vocal cord paralysis treatment.
1. Purpose: Vocal cord implants are generally used in patients with unilateral vocal cord paralysis. Its purpose is to permanently bulk up the paralyzed vocal cord, allowing it to close better with the healthy vocal cord and thus produce a clearer voice.
How It’s Performed: This procedure is usually performed under sedation anesthesia, meaning the patient is asleep. The surgeon makes a small incision in the neck area to access the back of the vocal cords and places the implant. It is a surgery similar to a breast implant. The implant helps the vocal cords to be closer, aiding in better voice production. During the procedure, the patient is asked to speak to determine if the voice has improved sufficiently, ensuring the ideal implant placement.
Implant Materials: Implants are generally made of biocompatible, non-resorbable materials such as silicone or Gore-Tex. These materials are not rejected by the body and offer a permanent solution.
Effects: A vocal cord implant can help strengthen the voice, reduce effort during speech, and improve voice quality. It can also facilitate swallowing in some patients.
Risks and Side Effects: Like any surgical procedure, vocal cord implantation carries risks such as infection, bleeding, and anesthesia-related complications. Additionally, complications such as implant displacement or rejection by the body may occur. These risks are very rare. There is no risk of voice loss.
Recovery Process: The recovery process usually takes several weeks. During this period, it is important for patients to avoid excessive voice use and follow their doctor’s recommendations.
What is Vocal Cord Nerve Transfer Surgery (Laryngeal Reinnervation)?
Vocal cord nerve transfer surgery, also known as vocal cord nerve transplantation, is a surgical procedure used in cases where the nerves controlling the vocal cords are damaged. This surgery is performed specifically for vocal cord paralysis to improve the voice and partially or completely restore vocal cord function. Here are the key features of this surgery:
Purpose: The primary goal of the surgery is to replace or connect damaged or dysfunctional vocal cord nerves with another healthy nerve. This helps restore the function of vocal cord movements, thereby contributing to voice improvement. During this procedure, no foreign material is placed in the body; the body heals with its own tissue.
How It’s Performed: The surgeon typically takes another nerve from a region of the neck and connects it to the damaged vocal cord nerve. This is usually performed under general anesthesia, meaning the patient is asleep. The harvested nerve is typically a nerve from one of the small muscles on the same side of the neck, and this nerve is redirected to reanimate the vocal cord.
Which Nerves Are Used: Mostly, a nerve from one of the muscles that assist in swallowing in the neck is used. These nerves have the potential to effectively move the vocal cords. No loss of function is observed in these muscles due to the use of these nerves.
Effects: Successful nerve transfer surgery can help strengthen the voice and improve its control. Significant improvements in patients’ voice quality and speaking abilities can be observed.
Risks and Side Effects: As with any surgical procedure, this surgery carries risks such as infection, bleeding, and anesthesia-related complications. Additionally, it may take time for the nerve to adapt to its new location and function after the nerve transfer procedure.
Recovery Process: The recovery process typically varies from several weeks to several months. During this period, it is important to follow the doctor’s recommendations.
What Are the Treatment Methods for Bilateral Vocal Cord Paralysis?
In cases of bilateral vocal cord paralysis, methods such as laser breath widening surgery or vocal cord nerve transfer surgery (laryngeal reinnervation) may be applied. Laser breath widening surgery offers a solution for shortness of breath in patients with bilateral vocal cord paralysis. This surgery aims to improve vocal cord movement and enhance the patient’s breathing ability. Common treatment options include:
Voice Therapy: Involves working with a speech-language pathologist to improve voice quality and strength. Techniques such as breath support exercises, vocal cord strengthening exercises, and strategies to keep the airway open during speech can be used.
Laser Breath Widening Surgery
Laser breath widening surgery offers a solution for shortness of breath in patients with bilateral vocal cord paralysis. This surgery aims to improve vocal cord movement and enhance the patient’s breathing ability. During the surgery, a portion of the vocal cords is removed using a laser. This procedure allows the vocal cords to move more, thereby enabling better breathing. The surgery is performed orally and has an immediate effect on breathing.
Injections: In some cases, especially when vocal cord paralysis is partial or in early stages where recovery is expected, injections are used for treatment.
Bilateral vocal cord nerve transfer – 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 worldwide. In Turkey, it was first performed by Dr. Necati Enver. It is the only treatment method that can enable vocal cords to move and improve both breathing and voice.
Tracheostomy: This is a treatment method that can be used, especially in emergencies, when there is difficulty breathing. Tracheostomy creates a direct airway in the windpipe, bypassing the vocal cords.
The choice of treatment depends on the cause of the paralysis, the patient’s general health status, vocal demands, and the presence of other medical conditions.
Is There Non-Surgical Treatment for Vocal Cord Paralysis?
Yes, non-surgical methods such as voice therapy and non-surgical vocal cord injection are available for vocal cord paralysis. Voice therapy plays an important role in the treatment of vocal cord paralysis and helps patients improve their voices. Non-surgical vocal cord injection, on the other hand, is a method used to add volume to the vocal cords and is generally performed under local anesthesia.
Voice Therapy for Vocal Cord Paralysis
Voice therapy plays an important role in the treatment of vocal cord paralysis and helps patients improve their voices. Voice therapy teaches patients to use their vocal cords more effectively and helps strengthen their voices. This therapy is typically conducted by a speech therapist and includes various exercises and techniques to improve the voices of patients with vocal cord paralysis.
Ideal patients for effective voice therapy are those with mild hoarseness due to vocal cord paralysis or patients who have undergone vocal cord injection-implantation and require support.
Here are some key points explaining the role of voice therapy:
Improving Voice Quality: Voice therapy offers exercises designed to make the voice clearer and more understandable. This aims to utilize the existing capacity of the vocal cords in the best possible way.
Breath Control: Breath control is vital for voice production. Therapy enables patients to use their breath more effectively and learn proper breathing techniques while speaking.
Increasing Voice Power: Individuals with vocal cord paralysis may often struggle to raise their voice. Voice therapy offers techniques to increase voice power and projection.
Ensuring Comfort During Speech: Therapy teaches patients techniques that allow them to feel less fatigued and more comfortable while speaking.
Vocal Hygiene: Vocal hygiene is important for maintaining vocal health. Therapists provide education on avoiding habits that can harm the vocal cords and methods for protecting the voice.
Individualized Treatment Plans: Every patient is different, and voice therapy is tailored to the individual’s specific needs. The therapist develops a treatment plan appropriate for the patient’s condition and goals.
Psychological Support and Motivation: Vocal cord paralysis can affect a person’s way of expressing 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 as needed.
Non-Surgical Vocal Cord Injection for Vocal Cord Paralysis
Non-surgical vocal cord injection is a method used in the treatment of vocal cord paralysis and is generally performed under local anesthesia. This method is used to add volume to the vocal cords and helps alleviate symptoms such as hoarseness. Vocal cord injection helps the vocal cords to be in a closer position, allowing for a clearer voice.
It is important to be aware of vocal cord paralysis, its diagnosis, and treatment methods. Imaging techniques such as computed tomography can assist in the diagnosis of vocal cord paralysis. The treatment of vocal cord paralysis varies depending 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.
