Summary about Disease
Vocal cord paralysis occurs when one or both of the vocal cords (vocal folds) don't open or close properly. This can disrupt speaking, breathing, and swallowing. It happens due to nerve damage affecting the larynx (voice box). The severity of symptoms varies depending on whether one or both cords are affected and the underlying cause. Treatment aims to improve voice, breathing, and swallowing functions.
Symptoms
Hoarseness
Breathy voice
Voice fatigue
Loss of vocal pitch
Difficulty speaking loudly
Choking or coughing while eating or drinking
Shortness of breath, especially during exertion
Noisy breathing (stridor)
Frequent throat clearing
Causes
Surgery: Common cause; thyroid, parathyroid, neck, chest, or brain surgeries.
Neurological Conditions: Stroke, multiple sclerosis, Parkinson's disease, myasthenia gravis.
Tumors: Tumors in the brain, neck, chest, or at the base of the skull can press on or invade the nerves that control the vocal cords.
Infections: Viral infections that inflame the nerves in the larynx.
Trauma: Injury to the neck or chest.
Idiopathic: In some cases, the cause is unknown.
Medicine Used
There isn't a specific medication to cure vocal cord paralysis. Medications are often used to manage related symptoms or underlying conditions.
Proton pump inhibitors (PPIs) or H2 blockers: If acid reflux is contributing to the problem.
Botulinum toxin (Botox): Injections into the vocal cords can help reduce muscle spasms or improve vocal cord positioning in some cases. (Though generally, treatment is surgical).
Is Communicable
Vocal cord paralysis is not communicable. It is caused by nerve damage and not by an infectious agent.
Precautions
Prevention of underlying causes: Managing risk factors for stroke, avoiding smoking (linked to certain cancers), and seeking prompt treatment for infections.
Post-operative care: After surgery, following all instructions carefully to minimize the risk of nerve damage.
Voice therapy: Consistent adherence to voice therapy exercises to improve vocal cord function and compensate for paralysis.
Dietary Modifications: Changes to what and how you eat to prevent aspiration (food or liquid entering the lungs)
How long does an outbreak last?
Vocal cord paralysis is not an "outbreak" situation. It's a condition resulting from nerve damage. The duration of symptoms depends on the cause, severity, and treatment. In some cases, it may be permanent; in others, it may improve with treatment or time.
How is it diagnosed?
Medical History and Physical Exam: Review of symptoms, medical history, and examination of the head and neck.
Laryngoscopy: Direct or indirect visualization of the vocal cords using a scope.
Laryngeal Electromyography (LEMG): Measures the electrical activity in the laryngeal muscles to assess nerve function.
Imaging Studies: CT scan or MRI of the head, neck, and chest to identify tumors or other structural abnormalities.
Voice Assessment: Evaluation by a speech-language pathologist to assess voice quality and function.
Timeline of Symptoms
The onset of symptoms can vary:
Sudden: After surgery, trauma, or a sudden neurological event (like a stroke).
Gradual: Develops over weeks or months with tumors or progressive neurological conditions.
Intermittent: Some symptoms may be more noticeable at certain times, such as when tired or speaking for extended periods.
Important Considerations
Breathing Difficulties: Bilateral vocal cord paralysis (both cords affected) can cause significant breathing problems and may require a tracheostomy (surgical opening in the trachea).
Aspiration Risk: Paralysis can increase the risk of aspiration pneumonia due to difficulty swallowing.
Voice Therapy: Speech therapy is often a crucial part of management, even if surgery is performed.
Team Approach: Management often involves a multidisciplinary team including otolaryngologists (ENT doctors), speech-language pathologists, neurologists, and pulmonologists.
Underlying Cause: Identifying and treating the underlying cause of the paralysis is essential for long-term management.