Vocal Cord Paralysis

Vocal Cord Paralysis

Vocal cord paralysis not only impairs or eliminates the voice, but can also lead to dangerous shortness of breath. Inflammation, cancer or vascular damage can be the causes. Therefore, medical treatment is always indicated when symptoms of vocal cord paralysis occur.

What is vocal cord paralysis?

Vocal cord paralysis describes a functional restriction in the various muscles of the larynx. The musculus vocalis (voice muscle), which as part of the inner larynx musculature adjusts the tension of the vocal cords, is particularly affected. The doctor speaks of a recurrent nerve paresis. Recurrens is the abbreviation for “Nervus laryngeus recurrens”. For what is leukodystrophy used for, please visit fun-wiki.com.

A paresis is an incomplete paralysis. However, vocal cord paralysis can also be due to a total loss of recurrence and is then a so-called “paralysis”.

There are basically 2 forms of vocal cord paralysis:

  1. Unilateral, due to the paralysis of only one vocal cord, the glottis becomes asymmetrical
  2. Bilateral, due to the paralysis of both vocal cords, the glottis remains symmetrical

Significant differences in the symptoms separate the two variants of vocal cord paralysis.

Causes

Vocal cord paralysis is usually caused by operations on the thyroid gland. If the filigree recurrent vein is mechanically damaged, the conduction of stimuli into the larynx muscles is disrupted.

Thyroid tumors and tumors in the upper chest area can also affect the recurrent nerve. Because the left recurrent vein runs from the brain (branching from the vagus nerve), initially descending between the esophagus and trachea, in order to bend back headward to the larynx (hence the term “regressive” – it is noteworthy that the right recurrent vein deviates from the course described).

Due to this “detour” this nerve is susceptible to diseases not only of the neck but also of the upper chest. Therefore, an aortic aneurysm (bulging of the main artery) can also damage the recurrent veins. Finally, there are nerve inflammations that affect the recurrent laryngeal nerves. Ultimately, the result is vocal cord paralysis.

Symptoms, Ailments & Signs

Depending on whether the disorder is unilateral or bilateral and the position of the paralyzed vocal cords, different symptoms can occur. Typically, vocal cord paralysis causes hoarseness and voice disorders. The voice can no longer be heavily used before the aforementioned hoarseness and finally temporary loss of voice occur.

Breathing is usually very noisy, with sounds ranging from rattling to wheezing. Accompanying this, it can lead to a dry cough and swallowing disorders. As a result of the limited supply of oxygen, what is known as hunger for air occurs, in which those affected appear to gasp for air. In addition, the vocal cord paralysis can lead to sleep disorders, which are accompanied by other symptoms.

The unilateral paralysis of the vocal cords is mainly expressed by hoarseness and a weak voice. High notes can only be sustained with great effort. Bilateral vocal cord paralysis becomes noticeable through increasing shortness of breath. As a result, those affected are quickly exhausted and can usually no longer pursue strenuous physical activities and 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 an accident.

Diagnosis & History

Vocal cord paralysis is expressed by hoarseness, which occurs in different degrees of severity. The problems of voice formation with unilateral paralysis of the vocal cords are usually less serious than with the unilateral manifestation of the clinical picture. Shortness of breath and breathing noises are typical of bilateral recurrent nerve palsy.

With these symptoms, the ear, nose and throat doctor performs a laryngoscopy ( laryngoscopy ). From the position of the vocal cords, the doctor recognizes the paralysis of the vocal cords and whether one or both vocal cords are affected. An electromyography ( EMG, similar to the EKG ) shows disturbances in the activity of the larynx muscles.

The chances of recovery from vocal cord paralysis depend on whether the recurrent nerve is irreversibly damaged or only acutely affected. As a rule, conservative or surgical methods lead to healing of a paralysis of the vocal cords.

Complications

First and foremost, there is a complete loss of voice due to vocal cord paralysis. The affected person can no longer speak, which significantly impairs communication with other people. The quality of life of the patient is thereby considerably restricted and reduced. Everyday life is also made significantly more difficult by the vocal cord paralysis.

Especially in children, this paralysis can lead to a significant impairment of development and delay it. Many of those affected also suffer from hoarseness and possibly shortness of breath. There are also frequent abnormal 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.

Those affected also suffer from coughing and difficulty swallowing. Difficulty swallowing can also make it difficult to eat and drink, resulting in dehydration or weight loss. Treatment for vocal cord paralysis depends on the cause.

In most cases, the symptoms can be relieved so that the person concerned can speak again. In the case of tumors, the further course depends very much on the type and severity 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 go to the doctor?

In the case of vocal cord paralysis, treatment by a doctor makes sense. 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 for vocal cord paralysis if the person affected suffers from severe hoarseness. As a rule, this does not go away on its own and cannot be treated by self-help measures. Difficulty swallowing or a strong cough also indicate this disease. In some cases, those affected also suffer from severe sleep disorders due to the vocal cord paralysis, which can have a negative effect on the general condition of the person concerned.

Vocal cord paralysis can usually be treated relatively well by an ENT doctor or a general practitioner. However, it cannot generally be predicted whether complete healing can occur.

Treatment & Therapy

Vocal cord paralysis requires different therapies depending on whether it is unilateral or bilateral. Speech therapy voice training helps with unilateral recurrent paralysis. The aim is to straighten the slackened vocal cord so that voice formation is possible again. Electrotherapeutic measures stimulate the fibers of the retrograde laryngeal nerve. If these efforts are unsuccessful, the surgeon performs an operative tightening of the vocal cord.

A double-sided recurrent nerve palsy first requires elimination of the shortness of breath. The glottis is often narrowed to such an extent that a tracheotomy must be performed urgently and immediately. The trachea is opened directly below the larynx, creating an artificial breathing hole. This “tracheostoma” is later to be replaced by an operative correction of the vocal cords. The enlargement of the glottis is also possible by reducing the size of the vocal cords with the laser. Often, however, a disturbed voice formation remains. Then the insertion of implants in the vocal cords promises to improve the situation.

In addition to these symptomatic therapeutic approaches, the cause of the nerve damage must be found and eliminated if possible. This is particularly important in the case of tumors and aortic aneurysms, but nerve inflammation must also be combated. The serious causes always require medical treatment of vocal cord paralysis.

Prevention

In order to prevent vocal cord paralysis, it is important to protect the respiratory tract. Smoking or overarching bronchial infections can ultimately also affect the declining laryngeal nerves. Of course, other causes, such as congenital aortic aneurysms, can only be corrected afterwards and cannot be used to prevent subsequent vocal cord paralysis.

Aftercare

Follow-up care is required if vocal cord paralysis is treated surgically. If the intervention affects a unilateral vocal cord paralysis, strain on the voice is possible just a few days later. Normally, an improved carrying capacity of the voice can be noted. Depending on which surgical material was used, the success of the therapy decreases again a few weeks or months after the operation.

This is especially the case when the material dissolves by itself. If, on the other hand, permanent implantation material is used, the success of the treatment is reflected in the voice. If the operation takes place in the case of bilateral vocal cord paralysis, the patient will feel a significant improvement in breathing shortly after the operation.

In the first few days after the surgical treatment, wound deposits threaten to narrow the airways, which can make another operation necessary. As a rule, however, the success of the treatment is permanent after the wound has healed. Subsequent check-ups play an important role after surgery for vocal cord paralysis. Once the patient has left the hospital, he or she arranges appointments with the treating surgeon at short notice. The doctor checks the result of the treatment and whether the voice has improved. In the case of bilateral vocal cord paralysis, the respiratory capacity should also be checked.

You can do that yourself

In the case of vocal cord paralysis, maintaining calm and sovereignty is particularly important. Hectic, stress or aggressive energies should be avoided as a matter of principle. In the event of an unfavorable course, the disturbance of the voice environment can also lead to shortness of breath. Therefore, any excitement should be avoided.

Communication should take place in other ways using alternative methods. With hand signals, writing down words or using modern digital tools, you can work well in everyday life. This enables the exchange with other people and can be used at any time if there is a need for clarification.

If the person concerned notices that inner restlessness or nervousness is developing, they should consciously leave the situation. Breathing slowly, sitting, or lying down can help reduce anxiety. All movements should be slowed down. This goes a long way to counteracting excitement or rushing.

The physical movements should also be adapted to the needs of the person concerned. During sports activities, the limits of the organism must be observed. It can lead to an increase in symptoms or a life-threatening condition if the person concerned asks too much of themselves. Lozenges or anti-irritant products such as candy can be used to prevent coughing or a sore throat.

Vocal Cord Paralysis