Vocal Cord Paralysis

What are the Symptoms of Vocal Cord Paralysis?

General symptoms of vocal cord paralysis are hoarse, cracked or wheezy voice, shortness of breath and exhaustion, air mixing into the voice during speech, vocal fatigue and difficulty swallowing saliva, food getting into the trachea during feeding and the danger of choking that manifests itself with a coughing attack, and the return of liquids through the nose.

The position of the vocal cords at the time of vocal cord paralysis causes the symptoms of paralysis to vary. Depending on the openness of the vocal cords, hoarseness in the voice or difficulty in breathing appear as the most obvious symptom. In general, if paralysis occurs when the vocal cords are in the middle, close to their closed position, breathing problems predominate, and if paralysis occurs when they are on the sides, close to their open position, hoarseness problems predominate. Although it is very rare, if paralysis occurs when both vocal cords are in a fully closed or slightly opened position; breathing cannot be taken and emergency intervention is required.

In order to diagnose vocal cord paralysis, an initial examination should be performed by an ear-nose-throat specialist. With this examination, issues such as whether the problem causing the complaints is paralysis of the vocal cords, whether the paralysis is in one or both vocal cords, the level of paralysis, and whether there is another factor are determined. In the first examination, the structure and functionality of the vocal cords are examined with endoscopic devices called laryngoscopy or stroboscopy, which visualize the vocal cords and their surroundings, and voice analysis programs. The functionality of the muscles in the larynx that move the vocal cords is examined using an electromyography (EMG) device that measures the electrical potential of the muscle by entering the muscle with a needle (electrode). If swallowing and feeding problems are present, fluoroscopy is used to examine the course of contrast agents such as barium and nonionic iodine in the body, especially between the mouth and esophagus.

If deemed necessary by the doctor, X-ray, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) examinations may be ordered simultaneously.

In the light of the complaints and symptoms, a diagnostic study is carried out to decide on the treatment method and whether surgical intervention is necessary.

What Causes Vocal Cord Paralysis?

Although the cause of some vocal cord paralysis is not fully understood, it is mostly caused by trauma or operational damage to the Nervus Vagus nerve during neck, throat, thyroid, heart and lung surgeries, or by infections and neurological problems that occur after these interventions. In addition to these reasons; infections not caused by any surgery, balance nerve inflammation (Vestibular Neuritis), goiter surgery, neck trauma, tumors in the larynx and surrounding organs, reflux, head traumas that damage the neural structure can also cause vocal cord paralysis.

How is Vocal Cord Paralysis Treated?

For patients diagnosed with vocal cord paralysis, first of all, voice therapy is applied to restore functionality to the vocal cord muscles and is supported with the necessary medication. If no improvement is seen with voice therapy and medication, a surgical operation is decided. The surgical method to be applied is determined according to the type of nerve affected, the position of the vocal cords at the time of paralysis, and whether the paralysis is unilateral or bilateral.

In surgical intervention, breath deprivation requires urgent intervention. This condition occurs when both vocal cords are immobilized in a closed or slightly open position as a result of loss of laryngeal sensation due to loss of function of the Nervus Vagus. In this case, a hole is made in the outer part of the neck between the 2nd and 3rd rings of the trachea (tracheostomy) and a tubular artificial channel (cannula) is inserted in order to ensure breathing and to prevent foreign substances from entering the trachea during eating and drinking. Endoscopic CO2 Laser Cordotomy (Kashima Procedure) or Arytenoidectomy (arytenoidectomy) surgery is then used to treat bilateral paralysis.

In the endoscopic CO2 laser cordotomy method; under general anesthesia, an endoscopic laser apparatus is inserted through the mouth area, an incision is made at the back of one of the vocal cords and the area is enlarged. In this way, space is created for breathing.

In arytenoidectomy surgery, the arytenoid cartilage in the larynx is removed.

In unilateral vocal cord paralysis, surgical intervention can be performed with methods such as Tissue Transplantation or Nerve Replacement (transplantation), Thyroplasty Type 1 (Isshiki Thyroplasty Type I - Medialization) and Filling (Injection) Therapy.

In the Tissue Transplantation method; the paralyzed vocal cord is pushed towards the middle region and tissue taken from another region of the patient is placed from the outside of the voice box inwards. The non-paralyzed vocal cord is allowed to vibrate better than the damaged vocal cord. In the Nerve Replacement method; the damaged nerve is removed and replaced with a healthy nerve in the neck area. Full recovery takes 6-9 months.

In thyroplasty, under sedation or local anesthesia, a permanent part (implant) is placed on the paralyzed vocal cord or fold to bring the two vocal cords into contact and close the gap between the vocal cords. A second operation is usually required to correct the position of the implant. The patient is discharged the day after the operation and recovery takes about a week.

In the Filling Treatment method; the paralyzed vocal cord is reached through an incision to be made in the mouth or neck area and filler (fat or collagen) is injected into the wire to increase the width of the vocal cord. In this way, the paralyzed vocal cord is brought closer to the middle region. The patient is discharged on the same day and recovery is seen within 2-3 days.

If you are experiencing hoarseness and breathing difficulties, you can contact us using our contact information; you can be treated in our center, which is dedicated to the diagnosis and treatment of vocal cord disorders, uses tools and apparatus equipped with the latest technologies, prioritizes your special demands and needs, and get more detailed information about your disease.