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Bilateral Vocal Fold (Cord) Paralysis

What is it?
Vocal folds must open to breathe, then close completely to produce a normal voice and cough.  Weakness or paralysis of both vocal folds means that there is nerve damage leading to limited or no movement of the vocal folds.  Vocal fold paralysis can be due to a number of underlying problems, such as a viral illness, external or internal trauma to the larynx, or a result of surgery performed in the chest (heart surgery, surgery of the great vessels, or esophagus surgery) or neck (thyroid surgery, parathyroid surgery, other neck surgery).  Sometimes no cause is identified.  Bilateral vocal fold paralysis often leads to both vocal folds sitting in a near-closed position.  While patients’ voices may be normal or only slightly hoarse, breathing is often significantly affected because the breathing passageway is narrowed at the level of the vocal folds.  In addition to dyspnea, patients may have noisy breathing, or stridor, at rest that is worse with exertion.

How is it treated?

Paralyzed vocal folds can be further evaluated by laryngeal electromyography to determine the extent of motor nerve injury, the nerve branches involved, and the likelihood that the nerves are going to “heal” after injury.  Depending on the timing and extent of injury, there are a number of treatments options.  Some patients may be left with their vocal folds in a more favorable position for breathing such that only observation is required to see if vocal fold function returns.  Other patients may require a tracheostomy tube for breathing.  Some patients may be candidates for an endoscopic, minimally-invasive procedure to improve breathing to either avoid a tracheostomy tube or to be able to have it removed.

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