A Family Doctor's Tale - VOCAL PARALYSIS

DOC I HAVE A VOCAL PARALYSIS

Vocal paralysis is a paralysis of one or both of the vocal cords and results in inability to close the the vocal cords completely.

Vocal paralysis usually involve one of the vocal cords.

If the vocal cords do not close completely:
1.the voice becomes weak and hoarse

2.there may be choking on swallowing due to food or liquids going down the windpipe.

The causes of vocal paralysis are:
1.tumors pressing on the nerve that control vocal cord movement
Examples are cancers of the larynx, thyroid, nasopharynx or esophagus

2.injury of the nerve controlling vocal cord movement
a.during thyroid and chest surgery
b.following radiation treatment to the neck  
c.neck injury.

3.stroke or neurological condition affecting the movement of the vocal cords

Symptoms  of vocal paralysis:
1.Hoarse voice

2.breathless voice

3.low pitch husky voice

4.vocal fatigue

5.choking or coughing especially on drinking liquids

Diagnosis of vocal paralysis:
1.history of voice problem

2.nasoendoscopy through the nose down to vocal cord under local anesthesia to check on the vocal cords and confirm the presence of  paralysis

3.videostroboscopy to view the vocal cords

4.CT or MRI Scanning of skull from nose to vocal box to look for cause of paralysis.

5.Laryngeal electromyography which use a fine needle to measure function of the vocal cord muscle

There can be complications of vocal paralysis such as:
1.choking with effect to breathing difficulty

2.chronic hoarseness of voice

Treatment of vocal paralysis:
Sometimes the recovery occurs by itself and no action is needed.
This may take up to one year.
Medical:
1.Speech therapy

2.injection of collagen to increase the bulk of paralysed vocal cord may help

Surgery:
1.Surgical treatment (medialization thyroplasty)may be needed to permently shift the paralysed vocal cord to improve the voice.
This operation is done under local anesthetic.

Phono-microsurgery is surgery to the vocal cord using micro-surgical techniques and instruments and sometimes lasers.

2.Rarely if both vocal cords are affected by paralysis there may be difficulty in breathing or noisy breathing because of the narrowed airway at the vocal box.
A tracheostomy may be needed. This involves making an opening in the windpipe and putting a trachecstomy tube into the opening to help breathing.

3.A laser procedure may be done to widen the the airway.

The prognosis of vocal paralysis is usually fairly good except when cancer is involved.

Prevention of vocal paralysis:
surgery around the neck and throat region should done carefully to avoid cutting the nerve to the vocal cords.