Vocal Fold Paresis/Paralysis, Unilateral (one-sided)

What is it?
Vocal folds must open to breathe, then close completely to produce a normal voice and cough.  Weakness or paralysis of one vocal fold means that there is nerve damage leading to limited or no movement of one of the vocal folds.  This can lead to incomplete closure at the vocal fold level and a resultant breathy voice, weak cough, and dysphagia (difficulty swallowing, especially liquids).  Vocal fold paresis or 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, or other neck surgery).  Sometimes no cause is identified (idiopathic).

 

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 improve with voice and swallowing therapy alone, while others may benefit from a temporary, office-based injection into the vocal folds to strengthen the voice and cough, while improving swallowing.  Ultimately, patients who are unable to recover movement of the affected vocal fold may benefit from a permanent implant into the larynx that repositions the vocal fold and restores voice, cough, and swallowing functions.