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Vocal cord paralysis is a rare but serious cause of hoarseness. Normally, the two vocal cords act as a valve in the upper airway, opening for breathing and closing during speech and swallowing.
When one vocal cord stops moving (unilateral vocal cord paralysis), this valve can leak, resulting in a weak and breathy voice. Sometimes, these voice problems are accompanied by swallowing difficulties because food and liquid can now pass more easily into the voice box and airway, instead of into the back of the throat and esophagus.
When both vocal cords stop moving (called bilateral vocal cord paralysis), breathing problems usually occur because the upper airway valve cannot open widely. Swallowing difficulties and hoarseness can also result. The treatment options are much different than for unilateral vocal cord paralysis.
Two nerves, one on each side of the body, control vocal cord opening and closing. They start in the lower part of the brain, travel through the neck, into the chest, and ultimately return to the voice box (hence their name: recurrent laryngeal nerves). Any disease or surgery that disrupts signal transmission along these pathways can impair vocal cord motion.
In the case of unilateral (one-sided) vocal cord paralysis, the vocal cord gap that results during speech can usually be reduced by pushing the non-moving vocal cord towards the middle with an injection into it. Early after the onset of vocal cord paralysis, we may not know whether the vocal cord will start to move again. The use of a temporary injectable material, which lasts several months, is ideal, because laryngoplasty surgery may not be needed if the vocal cord recovers motion on its own again.
Many ear, nose, and throat (ENT) physicians only perform vocal cord injections in the operating room, under general anesthesia. At the Voice Center, we routinely inject an immobile vocal cord in the office in a matter of minutes, using only topical anesthesia while the patient is wide awake. Patients often walk out of the examination room with a dramatically better-sounding voice, restoring their ability to communicate and avoiding general anesthesia. We can even perform this procedure at the bedside for hospitalized patients, speeding their recovery and discharge.
For patients with unilateral vocal cord paralysis that does not recover, we believe that surgery to reposition the paralyzed vocal cord — as opposed to a vocal cord injection — is the most precise way to achieve a permanently better voice. In a medialization laryngoplasty, we place an inert, non-absorbable medical-grade implant to push the paralyzed vocal cord into better position for speaking. We perform this operation with the patient awake, using local anesthesia, so that his or her voice can be "tuned" to its optimal sound in the operating room. This technique allows for greater accuracy in vocal cord re-positioning than a vocal cord injection alone because the implant can be dynamically manipulated during the operation. Patients typically stay in the hospital overnight following the operation.
Depending on the severity of the unilateral vocal cord paralysis, some patients require special additional surgeries (adduction arytenopexy and/or cricothyroid subluxation) that were developed by the laryngeal surgeons at the Mass General Voice Center. We perform these supplemental surgeries in combination with a medialization laryngoplasty, but they can substantially improve the voice when a medialization laryngoplasty alone fails to produce significant improvement. Very few ENT surgeons and laryngeal surgeons routinely perform these additional operations.
Voice Center (Center for Laryngeal Surgery and Voice Rehabilitation)
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