Vocal cord paralysis not only affects or stops your voice, but can also cause dangerous shortness of breath. Inflammation, cancer or vascular damage may be the causes. Therefore, medical treatment is always indicated at the onset of vocal cord paralysis symptoms.
What is vocal cord paralysis?
Schematic diagram showing the anatomy of the vocal cords and their various disorders. Click to enlarge. Vocal cord paralysis refers to a functional impairment in the various muscles of the larynx. Specifically affected is the vocalis muscle (voice muscle), which as part of the inner laryngeal muscles sets the tension of the vocal cords. The doctor refers to this as recurrent paresis. Recurrens is the abbreviation for “recurrent laryngeal nerve”. A paresis is a paralysis that is not completely pronounced. However, vocal cord paralysis can also be due to a total failure of the recurrent nerve and is then a so-called “paralysis”. Vocal cord paralysis basically occurs in 2 forms:
1. unilateral, due to the paralysis of only one vocal cord the glottis becomes asymmetrical
2. bilateral, by paralysis of both vocal cords the glottis remains symmetrical.
Significant differences in symptomatology separate the two variants of vocal cord paralysis.
Causes
Vocal cord paralysis is causally caused mostly by surgery on the thyroid gland. When the filigree recurrens is mechanically damaged in the process, a disturbance in the conduction of impulses to the laryngeal muscles results. Tumors of the thyroid gland as well as in the area of the upper chest can also attack the recurrens. This is because the left recurrent nerve runs from the brain (branching off from the vagus nerve), first descending between the esophagus and trachea, and then bending back towards the head to reach the larynx (hence the term “retrograde” – it is worth noting that the right recurrent nerve deviates from the course described). Because of this “detour”, this nerve is susceptible to disease events not only of the neck, but also of the upper chest. Therefore, an aortic aneurysm (bulging of the aorta) can also damage the recurrens. Finally, there are nerve inflammations that affect the recurrens. The consequence here is also ultimately vocal cord paralysis.
Symptoms, complaints, and signs
Depending on whether the disorder is unilateral or bilateral and the position of the paralyzed vocal cords, different symptoms may occur. Typically, vocal cord paralysis results in hoarseness and voice disorders. The voice can no longer be strained much before the aforementioned hoarseness and eventually temporary voice loss occur. Breathing is usually very noisy, and the sounds can range from rasping to wheezing. Accompanying irritable cough and dysphagia may occur. As a result of the restricted oxygen supply, the so-called air hunger occurs, in which the affected person appears to gasp for air. In addition, the vocal cord paralysis can lead to sleep disturbances, which are accompanied by further complaints. The unilateral vocal cord paralysis is mainly manifested by hoarseness and a powerless voice. High notes can only be sustained with great effort. Bilateral vocal cord paralysis is characterized by increasing shortness of breath. As a result, those affected quickly become exhausted and are usually no longer able to perform strenuous physical activities or sports. In the long term, this also leads to a decrease in quality of life and well-being. Symptoms of vocal cord paralysis usually develop acutely after the vocal cords have been damaged during surgery or in an accident.
Diagnosis and progression
Vocal cord paralysis is manifested by hoarseness, which occurs in varying degrees of severity. In this case, voice production problems are usually less severe in unilateral vocal cord paralysis. Shortness of breath and breath sounds are typical of bilateral recurrent paralysis. In the case of these symptoms, the ear, nose and throat specialist performs a laryngoscopy (laryngoscopy). By the position of the vocal cords, the physician recognizes the vocal cord paralysis and whether one or both vocal cords are affected. An electromyography (EMG, similar to the ECG) shows disturbances in the activity of the laryngeal muscles. The chances of recovery from vocal cord paralysis depend on whether the recurrent larynx is irreversibly damaged or only acutely affected.Usually, conservative or surgical methods lead to cure of vocal cord paralysis.
Complications
First and foremost, a complete loss of voice occurs due to vocal cord paralysis. As a result, the affected person can no longer speak, which significantly affects communication with other people. As a result, the patient’s quality of life is significantly limited and reduced. Everyday life is also made significantly more difficult by vocal cord paralysis. Especially in children, this paralysis can lead to a significant impairment of development and delay it. Furthermore, many affected persons suffer from hoarseness and possibly also from shortness of breath. Likewise, there are often pathological breathing sounds. In severe cases, vocal cord paralysis can also lead to a loss of consciousness and thus damage to the internal organs due to the breathing difficulties. Affected individuals also suffer from coughing and difficulty swallowing. The difficulty in swallowing may also cause difficulty in taking food and liquids, causing sufferers to suffer from dehydration or lose weight. Treatment for vocal cord paralysis depends on the cause. In most cases, the symptoms can be alleviated so that the affected person can speak again. In the case of tumors, the further course depends very much on the type and extent of the tumor, so that no general prediction can be made about the course of the disease. In most cases, however, life expectancy is not negatively affected.
When should you see a doctor?
In the case of vocal cord paralysis, treatment by a doctor is advisable. Since this disease usually cannot heal itself and the symptoms continue to worsen if left untreated, a doctor should always be consulted at the first signs and symptoms of vocal cord paralysis. In any case, early diagnosis has a positive effect on the course of the disease. A doctor should be consulted in case of vocal cord paralysis if the affected person suffers from severe hoarseness. As a rule, this does not disappear on its own and cannot be treated by self-help measures. Furthermore, swallowing difficulties or a strong cough also indicate this disease. In some cases, the affected person also suffers from severe sleep problems due to the vocal cord paralysis, which can have a negative effect on the general condition of the affected person. Vocal cord paralysis can usually be treated relatively well by an ENT specialist or by a general practitioner. However, it cannot generally be predicted whether a complete cure can be achieved.
Treatment and therapy
Vocal cord paralysis requires different therapies depending on whether it is unilateral or bilateral. In unilateral recurrent paresis, speech therapy voice training helps. The goal is to straighten the slackened vocal cord so that voice production becomes possible again. Electrotherapeutic measures stimulate the fibers of the recurrent laryngeal nerve. If these efforts are unsuccessful, the surgeon performs surgical tightening of the vocal cord. Double-sided recurrent paresis first requires elimination of respiratory distress. The glottis is often narrowed to the point that a tracheostomy must be performed urgently and immediately. This involves opening the trachea directly below the larynx to create an artificial breathing hole. This “tracheostoma” is to be replaced later by surgical correction of the vocal cords. Widening of the glottis is also possible by reducing the size of the vocal cords with a laser. Often, however, a disturbed voice tone remains. Then the insertion of implants on the vocal cords promises an improvement of the situation. In addition to these symptomatic therapeutic approaches, the cause of the nerve damage must be found and, if possible, eliminated. This is a priority especially in the case of tumors and aortic aneurysms, but nerve inflammation must also be addressed. The serious causes always require medical treatment of vocal cord paralysis.
Prevention
To prevent vocal cord paralysis, the main thing that should be done is to protect the respiratory tract. Smoking or encroaching bronchial infections can ultimately affect the regressing laryngeal nerves. Admittedly, other causes such as congenital aortic aneurysm can only be corrected retrospectively and are beyond the scope of prevention of subsequent vocal cord paralysis.
Aftercare
Follow-up care is required when vocal cord paralysis is treated surgically. If the surgery involves unilateral vocal cord paralysis, voice strain is possible a few days later. Normally, there is an improved ability to carry the voice. Depending on which surgical material was used, the success of the therapy is reduced again a few weeks or months after the operation. This is particularly the case if the material dissolves by itself. If, on the other hand, permanent implantation material is used, the success of the treatment is permanently evident in the voice. If the operation is performed in the case of bilateral vocal cord paralysis, the patient will feel a marked improvement in breathing shortly after the operation. In the first days after the surgical treatment, there is again a risk of narrowing of the airways due to wound deposits, which may make further surgery necessary. As a rule, however, the success of treatment is permanent after the wound has healed. An important role after surgery for vocal cord paralysis is played by the subsequent check-ups. Once the patient has left the hospital, he or she makes short-term appointments with the attending surgeon. During these appointments, the doctor checks the results of the treatment and whether the voice has improved. In the case of bilateral vocal cord paralysis, the breathing capacity should also be checked.
What you can do yourself
Maintaining calm and aplomb is especially important in vocal cord paralysis. Hectic, stress or aggressive energies are to be avoided as a matter of principle. In an unfavorable course, in addition to the disturbance of the vocal environment, respiratory distress may occur. Therefore, any excitement should be refrained from. Communication should take place in other ways using alternative methods. Hand signs, writing down words or the use of modern digital aids can work well in everyday life. This enables an exchange with other people and can be used at any time if clarification is needed. If the affected person notices that an inner restlessness or nervousness is developing, he or she should consciously step out of the situation. Slow breathing, sitting down or lying down can help to reduce inner agitation. All movement should be slowed down. This goes a long way toward counteracting an agitation or rush. Physical movements should also be adapted to the needs of the person concerned. During sporting activities, the limits of the organism should be taken into account. An increase in symptoms or a life-threatening condition may occur if the affected person demands too much of himself. Pastilles or soothing products such as candies can be used to prevent a cough or a scratchy throat.
