Larynx

Vocal Cord Paralysis

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Vocal Cord Paralysis, Laryngeal Nerve Palsy, Laryngeal Paralysis, Vocal Fold Paralysis

  • See Also
  • 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
  • Symptoms
  1. Hoarseness
  2. Decreased endurance for speech and voice Fatigue
  3. Swallowing difficulty or Choking on liquids
  4. Singing difficulty
  • Signs
  • Infants
  1. Stridor
  2. Apnea
  3. Cyanosis
  4. Dyspnea
  5. Hoarse voice
  6. Weak cry
  7. Feeding problems
  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
  • Evaluation
  1. See Speech Exam
  2. Careful lymph node examination
    1. See Lymphadenopathy of the Head and Neck
  • Radiology
  1. Chest XRay (consider lordotic views)
  • Management
  • General
  1. Laryngology or ENT referral in most cases
  2. Early speech pathology for voice building Exercises
  • 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
  • Complications
  1. Aspiration of food contents
  • Resources
  1. Voice Doctor Website (Dr. Thomas)
    1. http://www.voicedoctor.net/diagnose/sx/urln.htm