How Serious Is Vocal Cord Paralysis?

A few years ago, Larry Page, co-founder of Google, announced that he had been diagnosed with vocal cord paralysis. Just uttering the word paralysis seems rather daunting but Page went on to say that he would continue working despite his softer-than-normal voice which created challenges when speaking publicly.

Page says that his vocal cord issues (paralysis of his left vocal cord) actually began well over a decade before his announcement after he had gotten over a bad cold.

What is Vocal Cord Paralysis?
Vocal cord paralysis can impact an individual’s ability to speak and even breathe. It happens when the nerves that control the vocal cords are completely disrupted, preventing the folds in the cords from opening and closing correctly. (Partial disruption is referred to as vocal cord paresis.) Usually vocal cord paralysis occurs with one vocal cord. Paralysis in both vocal cords is rare and life threatening.

 
How Vocal Cords Work
To understand vocal cord paralysis, it helps to know how the vocal cords work. The cords are muscles located directly above the windpipe that close when we swallow and open when we breathe. When we speak, they operate like elastics; they move close to each other and close to vibrate together. However, if paralysis occurs, the cords remain open which leaves the airways open. The voice box can’t work properly, and food and liquids can pass through the opening directly into the lungs.

 
Causes of Vocal Cord Paralysis
There can be many causes1 for vocal cord paralysis including injuries to the head and neck, cancer of the lungs or thyroid, stroke, or diseases that affect the nervous system like Parkinson’s disease or multiple sclerosis. Vocal cord paralysis is not an “injury” and so it is not something that singers suffer from over singing. Those injuries are most commonly vocal nodules or vocal tears.

 
Symptoms of Vocal Cord Paralysis
The symptoms of vocal cord paralysis can range from changes in the voice to trouble breathing. They can include:

• Hoarseness
• Shortness of breath
• Trouble swallowing
• Choking or coughing when you eat
• Loss of volume in the voice – inability to speak louder
• People notice the quality or sound of your voice has changed

If these symptoms occur and do not resolve quickly, it’s important to consult an ear, nose, throat (ENT) specialist.

In order to diagnose vocal cord paralysis, the physician will ask questions about the changes your have experienced and will listen to your voice as you are speaking. The doctor may also examine your vocal cords with an endoscope, which is a tube with a light at the end.

 
How to Treat Vocal Cord Paralysis
If ENT doctors believe you have suffered vocal cord paralysis, they have several different treatment options to pursue to address the condition. They include:

• Speech language therapy: This is like physical therapy for the voice. A speech language therapist will help you to use your voice carefully to strengthen the vocal folds and encourage them to work properly again.
• Surgery: There are different types of surgery that can repair vocal cords, but they are not recommended as the first line of treatment. It can take up to a year1 for vocal cords to recover from paralysis, either on their own or through speech language therapy, and most ENT doctors want to give vocal cords a chance to recover before performing surgery. However, if surgery is recommended, there are several types:
  • Injections2: Some physicians may recommend injections into the vocal cord to close the gap caused by the paralysis. A substance such as body fat or collagen is injected to fill or “puff up” the vocal cord to make it thicker and easier to close.
  • Laryngeal framework surgery (also called medialization laryngoplasty): In this procedure a small incision is made in the neck and an implant is inserted. The implant is designed to move the voice box closer to the middle so that both vocal cords can vibrate together.
  • Vocal cord repositioning: Tissue from outside the voice box is pushed inward to push the vocal cords closer together.
  • Replacement of the damaged nerve (reinnervation): A healthy nerve can be taken from another area of the neck and used to replace the damaged vocal cord.

Research
The National Institute on Deafness and Other Communication Disorders (NIDCD) is heavily involved in research studies that attempt to uncover additional causes and treatments of vocal fold paralysis/paresis3. One surgical procedure that we spoke about earlier is laryngeal framework surgery, or medialization laryngoplasty.

Laryngeal framework surgery
Laryngeal framework surgery, a procedure designed to get the patient’s voice back, involves inserting a structural implant into the larynx (voice box) moving it closer to the middle and thus reinvigorating vocal cord vibration.

It’s an effective procedure but 25% of patients find themselves returning for a second surgery to better position the implant.

Since one surgery is always better than two, the NIDCD study is developing “a pre-operative planning system that uses 3-D computer modeling to determine the best location for, and configuration of, the implant.” In addition, an accompanying image-guided system allows the surgeon to “see” exactly where the vocal cord is positioned so that the implant is perfectly placed.

Electrical Stimulation Technology
The NIDCD also has also been at work researching the effectiveness of an implanted pacemaker which is designed to stimulate nerve impulses to the vocal cords and thus, allow them to function properly again (open for breathing and close for swallowing/speaking). This would be quite useful for paralysis in both vocal cords and would theoretically eliminate the need for a tracheotomy.

Vocal cord paralysis can cause concern, but as with many other medical conditions, consulting your ENT doctor offers you the best opportunity for diagnosis and effective treatment.

References

1: https://www.nidcd.nih.gov/health/vocal-fold-paralysis
2: https://www.mayoclinic.org/diseases-conditions/vocal-cord-paralysis/diagnosis-treatment/drc-20378878
3. https://www.nidcd.nih.gov/health/vocal-fold-paralysis