Vocal Cord Paralysis:What you need to know

Vocal Cord Paralysis is a distressing problem. An early checkup can be lifesaving. It may also help your doctor find a more serious underlying health problem. Both vocal cords or only one may be paralyzed. The left is more commonly affected than the right.

What are the symptoms of Vocal Cord Palsy?

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The symptoms may be varied. But the most common presentation is hoarseness. There may also be

Change in quality of voice
Forced whisper
Weak voice
Difficulty breathing
Noisy breathing
‘Severe persistent acid reflux
Haemoptysis or a cough stained with blood
Sore throat
Earache may be present. An important nerve which supplies your voice box also has a branch supplying the ear. Interestingly if the branch in larynx or voice box is irritated the ear starts to pain.

Significant info: A referred earache may be a serious complaint.

Types of Paralysis

Abductor
Adductor

Abductor Palsy: Vocal cords are like the cords in your Casiomini

Your vocal cords need to move, in order for you to breathe or speak. When you eat, they need to close properly so that the food from the food pipe cannot enter inside. Abductor palsy is when the vocal cords cannot be opened properly. The main problems that can occur are stridor or noisy respiration and respiratory obstruction which may need a tracheostomy.

Adductor Palsy: Vocal cords have problem closing but no difficulty breathing. Reflux is a major problem in this case and can persist even after treatment.

Major causes of Vocal Cord palsy

Malignant diseases: Bronchial carcinoma:50%
Thyroid Carcinoma
Nasopharyngeal carcinoma
Glomus tumor
Lymphoma Others
Nonsurgical neck trauma causing a hematoma in the neck can create pressure o the nerve and paralysis.
Post surgery involving Food pipe /esophagus, Lung, Heart, Thyroid and also post endotracheal intubation due to any cause.
Idiopathic often attributed to Post viral neuritis: Influenza, Epstein Barr Virus, Cytomegalovirus
Neurological: Multiple sclerosis, ALS, Parkinson’s, Head injury
Neuropathies associated with Diabetes, alcoholism, GB syndrome
Inflammatory causes like Tuberculosis of lungs, Syphilitic aortitis Common previous days)
Certain Drugs like cisplatin, vincristine

What your doctor will do and probably advice

A detailed history
Examination of the entire system with special stress on Neck, Thyroid, Chest
Local examination of Voice box or larynx
Clinical: Indirect laryngoscopy
FIbreoptic Laryngoscopy
Panendoscopy
Radiology: CT scan from Base of the skull to diaphragm sometimes CT head too.
Flow volume loop study

Is vocal cord paralysis curable?

If the cause is reversible (like drug neurotoxicity ) then vocal cord palsy may have excellent results after stopping the offending drug.

Treatment of Vocal Cord palsy?

It is multifaceted and may need life support if not treated on time.

Those due to drugs causing neurotoxicity, are often reversible after discontinuing the causative agent. Pyridoxine and pyridostigmine have helped in early recovery (within 1–2 weeks) of vincristine-induced peripheral neuropathy in a case series of patients. The cases of this drug causing peripheral neuropathy are more common in pediatric age group than adults.

Treatment of cause.
Treatment of symptom which may or may not include tracheostomy depending on the airway.
Speech therapy.
Patient counseling to cope with living with hoarseness and associated symptoms.