Larynx
Vocal Cord Paralysis
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Vocal Cord Paralysis
, Laryngeal Nerve Palsy, Laryngeal Paralysis, Vocal Fold Paralysis
See Also
Hoarseness
Causes
Unilateral Vocal Cord Paralysis (Most cases)
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
Endotracheal Intubation
Neck or thoracic surgery (most common cause in infants and young children)
Carotid surgery
Neck dissection for head and neck cancer
Cardiac surgery
Patent Ductus Arteriosus
ligation (newborns)
Valve repair
Thyroid
surgery
Tracheal surgery
Causes
Bilateral Vocal Cord Paralysis (rare)
Neurologic abnormalities
Trauma
or post-surgical
Chiari Malformation
Symptoms
Hoarseness
Decreased endurance for speech and voice
Fatigue
Weak or hoarse cry in infants
Swallowing
difficulty or
Choking
on liquids
Dysphagia
and aspiration risk
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
Nasolaryngoscopy
Evaluates appearance and movement of
Vocal Cords
Imaging
Chest XRay
(consider lordotic views)
Management
Gene
ral
Laryngology or ENT referral in most cases
Early speech pathology for voice building
Exercise
s
Bilateral Vocal Cord Paralysis typically requires
Tracheostomy
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]
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