Otolaryngology Book


Vocal Cord Paralysis

Aka: Vocal Cord Paralysis, Laryngeal Nerve Palsy, Laryngeal Paralysis, Vocal Fold Paralysis
  1. See Also
    1. Hoarseness
  2. Causes: Unilateral Vocal Cord Paralysis
    1. Tumor
      1. Infiltrating Thyroid Cancer
      2. Apical Lung Cancer
    2. Medications
      1. Vincristine
      2. Phenytoin
        1. Fried (1975) Laryngoscope 85:1770-81 [PubMed]
    3. Inflammation or Infection
      1. Collagen vascular disease
      2. Lyme Disease
      3. Mononucleosis
      4. Sarcoidosis
    4. Neurologic Conditions
      1. Myasthenia Gravis
      2. Parkinsonism
      3. Multiple Sclerosis
      4. Amyotrophic Lateral Sclerosis
    5. Toxic and Metabolic Causes
      1. Diabetes Mellitus
      2. Alcoholism
      3. Heavy Metal exposure
        1. Arsenic Poisoning
        2. Mercury Poisoning
        3. Lead Poisoning
    6. Trauma to recurrent laryngeal nerve
      1. Prolonged intubation
      2. Post-surgical
        1. Carotid surgery
        2. Neck dissection for head and neck cancer
        3. Cardiac surgery
          1. Patent Ductus Arteriosus ligation (newborns)
          2. Valve repair
        4. Thyroid surgery
        5. Tracheal surgery
  3. Symptoms
    1. Hoarseness
    2. Decreased endurance for speech and voice Fatigue
    3. Swallowing difficulty or Choking on liquids
    4. Singing difficulty
  4. Signs: Infants
    1. Stridor
    2. Apnea
    3. Cyanosis
    4. Dyspnea
    5. Hoarse voice
    6. Weak cry
    7. Feeding problems
  5. Signs: Laryngoscopy
    1. Paralyzed vocal cord is fixed in paramedian position
      1. Just lateral to midline
      2. Slight adduction may be seen (collateral innervation)
    2. Paralyzed vocal cord is bowed and flaccid
      1. When speaking, drops lower than the unaffected cord
    3. Uninvolved vocal fold may compensate
      1. Uninvolved cord crosses midline over next 2-3 months
      2. Meets paralyzed cord
  6. Evaluation
    1. See Speech Exam
    2. Careful Lymph Node examination
      1. See Lymphadenopathy of the Head and Neck
  7. Radiology
    1. Chest XRay (consider lordotic views)
  8. Management: General
    1. Laryngology or ENT referral in most cases
    2. Early speech pathology for voice building Exercises
  9. Management: Surgery for unilaterally paralyzed vocal cord
    1. Medialization Laryngoplasty (Thyroplasty) with implant
      1. Various implant types (e.g. Gore-Tex, Silicon)
    2. Medialization via office injection
      1. Collagen injections
      2. Avoid Teflon augmentation due to granulation
    3. Reinnervation
      1. Requires more time to result than other procedures
  10. Complications
    1. Aspiration of food contents
  11. Resources
    1. Voice Doctor Website (Dr. Thomas)
      1. http://www.voicedoctor.net/diagnose/sx/urln.htm
  12. References
    1. Feierabend (2009) Am Fam Physician 80(4): 363-70 [PubMed]
    2. House (2017) Am Fam Physician 96(11): 720-8 [PubMed]
    3. Rosen (1998) Am Fam Physician 57(11): 2775-2782 [PubMed]

Vocal Cord Paralysis (C0042928)

Definition (MSH) Congenital or acquired paralysis of one or both VOCAL CORDS. This condition is caused by defects in the CENTRAL NERVOUS SYSTEM, the VAGUS NERVE and branches of LARYNGEAL NERVES. Common symptoms are VOICE DISORDERS including HOARSENESS or APHONIA.
Definition (NCI) Paralysis of the muscles of one or both vocal cords. Signs and symptoms include hoarseness, weak voice, dyspnea, and coughing. Affected individuals are at risk for aspiration pneumonia.
Concepts Disease or Syndrome (T047)
MSH D014826
ICD9 478.30
SnomedCT 155542001, 302912005, 87424003
English Paralyses, Vocal Cord, Vocal Cord Paralyses, Vocal Cord Paralysis, Unspecified paralysis of vocal cords, Paralysis, Vocal Cord, VOCAL CORD PARALYSIS, vocal cord paralysis, vocal cord paralysis (diagnosis), Paralysis vocal cord, Palsies, Vocal Cord, Palsy, Vocal Cord, Vocal Cord Palsies, Vocal Cord Palsy, Total Vocal Cord Paralysis, Palsies, Vocal Fold, Palsy, Vocal Fold, Vocal Fold Palsies, Vocal Fold Palsy, Vocal cord paralysis NOS, Vocal Cord Paralysis [Disease/Finding], cord paralysis vocal, paralysis vocal cord, vocal cords paralysis, vocal fold palsy, vocal cord palsy, Paralysis of vocal cords or larynx, unspecified, Paralysis of vocal cords, VCP - Vocal cord palsy, Vocal cord palsy, Vocal cord paralysis, Vocal fold palsy, Vocal cord palsy (disorder), paralysis; vocal cords, vocal cord; paralysis
Portuguese PARALISIA DAS CORDAS VOCAIS, Paralisia de corda vocal, Paralisia NE das cordas vocais, Paralisia das Pregas Vocais, Paralisia das Cordas Vocais, Paralisia das cordas vocais
German STIMMBANDLAEHMUNG, Laehmung des Stimmbands, unspezifische Stimmbandlaehmung, Stimmbandlaehmung, Stimmbandlähmung
Dutch niet-gespecificeerde paralyse stembanden of larynx, paralyse stemband, paralyse; stembanden, stemband; paralyse, stembandparalyse, Stembandverlamming, Verlamming, stemband-
French Paralysie non précisée des cordes vocales, PARALYSIE DES CORDES VOCALES, Paralysie des cordes vocales
Italian Paralisi di corda vocale, Paralisi delle corde vocali non specificata, Paralisi totale delle corde vocali, Paralisi delle corde vocali
Spanish Parálisis de cuerda vocal, Parálisis no especificada de las cuerdas vocales, PARALISIS CUERDAS VOCALES, Parálisis de los Pliegues Vocales, parálisis de las cuerdas vocales, parálisis de las cuerdas vocales (trastorno), Parálisis de las Cuerdas Vocales, parálisis de cuerda vocal (trastorno), parálisis de cuerda vocal, parálisis de las cuerdas vocales (concepto no activo), Parálisis de las cuerdas vocales
Japanese 詳細不明の声帯麻痺, ショウサイフメイノセイタイマヒ, セイタイマヒ, 声帯麻痺, 喉頭麻痺
Swedish Stämbandsförlamning
Czech hlasivky - paralýza, Blíže neurčená obrna hlasivek, Obrna hlasivek, ochrnutí hlasivek, hlasivky - ochrnutí
Finnish Äänihuulihalvaus
Polish Porażenie struny głosowej
Hungarian Hangszalag paralysis, Hangszalagok nem meghatározott paralysise, Hangszalag bénulás
Norwegian Parese, stemmebånd, Lammelse, stemmebånd, Stemmebåndsparese, Paralyse, stemmebånd, Stemmebåndslammelse, Stemmebåndsparalyse
Derived from the NIH UMLS (Unified Medical Language System)

Laryngeal Paralysis (C0086523)

Concepts Disease or Syndrome (T047)
MSH D014826
ICD10 J38.0
SnomedCT 266349000, 195846000, 195841005, 195840006, 89927005
English Laryngeal Paralyses, Paralyses, Laryngeal, Paralysis, Laryngeal, LARYNGOPARALYSIS, Laryngoplegia NOS, Paralysis of larynx unspec., Paralysis of larynx unspecified, Laryngoparalysis, laryngeal paralysis, larynx paralysis, paralysis larynx, Paralysis of larynx unspecified (disorder), Laryngoplegia NOS (disorder), Larynx paralysis, Laryngeal paralysis, Laryngoplegia, Paralysis of larynx (disorder), Paralysis of larynx, laryngoplegia, larynx; paralysis, paralysis; larynx, Laryngoplegia, NOS, Paralysis of larynx, NOS, Laryngeal Paralysis
Portuguese PARALISIA LARINGEA, Paralisia laríngea, Paralisia Laríngea
Spanish PARALISIS LARINGEA, Laringoparálisis, Parálisis Laríngea, parálisis de laringe no especificada (trastorno), laringoplejía, SAI, parálisis de laringe no especificada, laringoplejía, SAI (trastorno), laringoplejía, parálisis de la laringe (trastorno), parálisis de la laringe, parálisis laríngea
Dutch laryngoparalyse, larynx; paralyse, paralyse; larynx, Larynxparalyse
German Laryngoparalyse, Laryngealparalyse, KEHLKOPFLAEHMUNG
Japanese 喉頭麻痺, コウトウマヒ
French Paralysie laryngée, PARALYSIE DES MUSCLES LARYNGES, Paralysie du larynx
Czech Paralýza laryngu
Hungarian Gégeizom bénulás
Norwegian Laryngealparalyse, Larynxparalyse
Italian Paralisi laringea
Derived from the NIH UMLS (Unified Medical Language System)

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