II. Causes: Unilateral Vocal Cord Paralysis
- Tumor
- Infiltrating Thyroid Cancer
- Apical Lung Cancer
- Medications
- Inflammation or Infection
- Collagen vascular disease
- Lyme Disease
- Mononucleosis
- Sarcoidosis
- Neurologic Conditions
- Toxic and Metabolic Causes
-
Trauma to recurrent laryngeal nerve
- Prolonged intubation
- Post-surgical
- Carotid surgery
- Neck dissection for head and neck cancer
- Cardiac surgery
- Patent Ductus Arteriosus ligation (newborns)
- Valve repair
- Thyroid surgery
- Tracheal surgery
III. Symptoms
- Hoarseness
- Decreased endurance for speech and voice Fatigue
- Swallowing difficulty or Choking on liquids
- Singing difficulty
V. Signs: Laryngoscopy
- Paralyzed vocal cord is fixed in paramedian position
- Just lateral to midline
- Slight adduction may be seen (collateral innervation)
- Paralyzed vocal cord is bowed and flaccid
- When speaking, drops lower than the unaffected cord
- Uninvolved vocal fold may compensate
- Uninvolved cord crosses midline over next 2-3 months
- Meets paralyzed cord
VI. Evaluation
- See Speech Exam
- Careful Lymph Node examination
VII. Radiology
- Chest XRay (consider lordotic views)
VIII. Management: General
- Laryngology or ENT referral in most cases
- Early speech pathology for voice building Exercises
IX. Management: Surgery for unilaterally paralyzed vocal cord
- Medialization Laryngoplasty (Thyroplasty) with implant
- Various implant types (e.g. Gore-Tex, Silicon)
- Medialization via office injection
- Collagen injections
- Avoid Teflon augmentation due to granulation
- Reinnervation
- Requires more time to result than other procedures
X. Complications
- Aspiration of food contents
XI. Resources
- Voice Doctor Website (Dr. Thomas)