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Vocal Cord Paralysis
Aka: Vocal Cord Paralysis, Laryngeal Nerve Palsy, Laryngeal Paralysis, Vocal Fold Paralysis
- See Also
- Hoarseness
- Causes: Unilateral Vocal Cord Paralysis
- Tumor
- Infiltrating Thyroid Cancer
- Apical Lung Cancer
- Medications
- Vincristine
- Phenytoin
- Fried (1975) Laryngoscope 85:1770-81 [PubMed]
- Inflammation or Infection
- Collagen vascular disease
- Lyme Disease
- Mononucleosis
- Sarcoidosis
- Neurologic Conditions
- Myasthenia Gravis
- Parkinsonism
- Multiple Sclerosis
- Amyotrophic Lateral Sclerosis
- Toxic and Metabolic Causes
- Diabetes Mellitus
- Alcoholism
- Heavy Metal exposure
- Arsenic Poisoning
- Mercury Poisoning
- Lead Poisoning
- 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
- Symptoms
- Hoarseness
- Decreased endurance for speech and voice Fatigue
- Swallowing difficulty or Choking on liquids
- Singing difficulty
- Signs: Infants
- Stridor
- Apnea
- Cyanosis
- Dyspnea
- Hoarse voice
- Weak cry
- Feeding problems
- 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
- Evaluation
- See Speech Exam
- Careful Lymph Node examination
- See Lymphadenopathy of the Head and Neck
- Radiology
- Chest XRay (consider lordotic views)
- Management: General
- Laryngology or ENT referral in most cases
- Early speech pathology for voice building Exercises
- 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
- Complications
- Aspiration of food contents
- Resources
- Voice Doctor Website (Dr. Thomas)
- http://www.voicedoctor.net/diagnose/sx/urln.htm
- References
- Feierabend (2009) Am Fam Physician 80(4): 363-70 [PubMed]
- House (2017) Am Fam Physician 96(11): 720-8 [PubMed]
- Rosen (1998) Am Fam Physician 57(11): 2775-2782 [PubMed]