What to Know About Vocal Cord Paralysis

Medically Reviewed by Christopher Melinosky, MD on March 07, 2024
3 min read

Your vocal cords play a more significant role in your body than simply helping you talk and sing. They protect your airway, prevent food, drink, and saliva from getting into your windpipe, and help keep you from choking. When your nerve impulses to your larynx, or voice box, are disturbed, you can have vocal cord paralysis. This condition makes it hard for you to speak or even breathe. 

Mild cases of vocal cord paralysis can improve with voice therapy and vocal rest. Depending on the damage to your vocal cords, you may need surgery. 

Your vocal cords are two elastic bands of muscle tissue in your voice box. Your vocal cords are located right above your windpipe or trachea. Vocal cords work by moving apart when you breathe and closing tightly when you swallow. The air from your lungs makes your vocal cords vibrate, and this helps you speak. 

Two types of paralysis can affect your vocal cords. Unilateral paralysis -- paralysis on one vocal cord -- is the most common. Bilateral paralysis -- which occurs on both cords -- is less common but can be more life-threatening. 

Unilateral vocal cord paralysis can be caused by: 

  • Brain tumors 
  • Tumors at the base of your skull 
  • Neck trauma
  • Thyroid gland tumors 
  • Neurotoxin poisoning like lead, arsenic, or mercury 
  • Diphtheria
  • Cervical spine injury 
  • Lyme disease
  • Viral illness

Bilateral vocal cord paralysis can be caused by: 

  • Thyroid and cervical surger
  • Tracheal intubation 
  • Trauma
  • Neuromuscular diseases
  • Neurodegenerative diseases

Anyone can have vocal cord paralysis. However, women are more likely to have this condition than men. 

If you have the following neurological conditions, you are likelier to get paralyzed vocal cords: 

You might notice slight changes in your voice that may seem to be caused by allergies or a cold. The severity of your symptoms will also depend on how your voice box adapts to the degree of paralysis. 

Vocal cord paralysis symptoms can range from mild to severe. They include: 

  • Hoarseness in your voice 
  • Breathy voice changes 
  • Shortness of breath 
  • Noisy breathing 
  • Difficulty swallowing 
  • Choking or coughing when you eat

Other symptoms include: 

  • Frequent breaths while speaking
  • Inability to talk loudly
  • Loss of gag reflex
  • Frequent throat clearing

After surgery, you’ll need a strong base of support to help you recover and avoid talking as much as possible. Keeping the damage minimal can help to speed up your recovery. 

Your treatment for vocal cord paralysis will depend on the cause and severity of your symptoms. Treatments may include:

Voice therapy. Voice therapy helps strengthen your vocal cords. Your speech-language pathologist may have you do exercises that help you control your breathing while you talk or help reduce tension in your other muscles around your paralyzed vocal cords.

Surgery. You will need surgery if your vocal cords don’t fully recover by themselves. Your options for surgery include: 

  • Bulk injection, which fills your vocal cords with collagen or another filler substance 
  • Structural implants, also known as thyroplasty or medialization laryngoplasty, that reposition your vocal fold  
  • Vocal cord repositioning, in which your tissue from the outside of your voice box moves inward 
  • Replacement of the damaged nerve
  • A tracheotomy, which is for bilateral paralyzation

The doctor will also help you learn how to take care of your breathing tube if you’ve had a tracheotomy. 

After surgery, a speech-language pathologist will help you learn how to use your voice. You’ll need to avoid talking, so a strong support system is necessary while you recover. 

Emerging treatments. Some research has shown that electrical stimulation can help open and close your vocal cords. This stimulation may come from a nerve in another part of your body or a device like a pacemaker.