Unilateral Vocal Fold Paralysis

Unilateral Vocal Fold Paralysis is a condition that can have a significant impact on a person’s ability to speak, breathe, and swallow. It occurs when one of the two vocal folds (also known as vocal cords) does not move properly or at all. This lack of movement can lead to a weak, breathy voice, difficulty in swallowing, and sometimes even breathing problems. At the International Voice Clinic, we understand how distressing vocal fold paralysis can be and are dedicated to providing comprehensive care that addresses both the physical and emotional aspects of this condition.

This page aims to help you understand what Unilateral Vocal Fold Paralysis is, how it affects the body, the various treatment options available, and what you can expect during the recovery process.

How Do The Vocal Folds Work In Healthy Individuals?

The vocal folds are located just above the windpipe. Each individual has two vocal folds. These two vocal folds are connected at one end and free at the other end, just like the letter “V”. Normal vocal folds open during breathing, and completely close during vocalization or swallowing.

What Does It Mean To Have Unilateral Or Bilateral Vocal Fold Paralysis?

Of our total of two vocal cords, paralysis is expressed as unilateral or bilateral, depending on the number of affected vocal folds, one or both.

What is Unilateral Vocal Fold Paralysis?

To understand Unilateral Vocal Fold Paralysis, it's helpful to first know a bit about how the vocal folds work. The vocal folds are two bands of muscle tissue located in the larynx (voice box). These folds open and close as we breathe, speak, and swallow. They come together to produce sound when we speak and move apart to allow air to pass through when we breathe.

In the case of Unilateral Vocal Fold Paralysis, one of these vocal folds does not move or moves very little. This can happen for various reasons, including nerve damage, surgical injury, viral infections, or tumors. The paralysis of one vocal fold means that it cannot come together with the other fold to produce a strong sound. As a result, the voice may become weak, breathy, or hoarse. Additionally, the inability of the vocal folds to close properly can lead to difficulties in swallowing and, in some cases, choking or aspiration (food or liquid entering the airway).

Causes of Unilateral Vocal Fold Paralysis

Unilateral Vocal Fold Paralysis can result from several different causes. Understanding the underlying cause is crucial for determining the best course of treatment. Some of the most common causes include:

1. Nerve Damage

The movement of the vocal folds is controlled by the recurrent laryngeal nerve, a branch of the vagus nerve. Damage to this nerve can result in paralysis of the vocal fold. Nerve damage can occur due to:

Surgical Injury: Procedures involving the neck, chest, or thyroid gland can sometimes result in accidental injury to the recurrent laryngeal nerve. The most common examples include thyroid (goiter) surgery, surgery of the cervical vertebrae, surgery of the heart and great vessels, and neurosurgery. Since the nerves supplying the vocal folds are very sensitive, loss of function can occur even during careful surgery, which is sometimes unavoidable.

Trauma: Injury to the neck or chest from accidents or other trauma can damage the nerve.

Infections: Viral infections, such as the common cold or herpes, can lead to inflammation and damage to the nerve.

2. Tumors

Tumors located in the neck, chest, or near the vagus nerve can compress the nerve, leading to vocal fold paralysis. This can include benign tumors, such as thyroid nodules, or malignant tumors, such as lung cancer.

3. Neurological Conditions

Certain neurological disorders, such as stroke or multiple sclerosis, can affect the nerves that control the vocal folds, leading to paralysis.

4. Idiopathic Causes

In some cases, the cause of Unilateral Vocal Fold Paralysis is unknown. This is referred to as idiopathic vocal fold paralysis. Despite thorough evaluation, the exact reason for the nerve dysfunction cannot be determined.

Symptoms of Unilateral Vocal Fold Paralysis

The symptoms of Unilateral Vocal Fold Paralysis can vary depending on the severity of the paralysis and the underlying cause. Common symptoms include:

1. Voice Changes

The most noticeable symptom of Unilateral Vocal Fold Paralysis is a change in the voice. This may include:

Breathy Voice: The voice may sound breathy or airy due to the inability of the vocal folds to come together properly.

Hoarseness: The voice may become hoarse or raspy.

Weak Voice: Patients may notice that their voice is weak or that they cannot project their voice as they used to.

Vocal Fatigue: Speaking for extended periods can lead to vocal fatigue, with the voice becoming weaker or more strained as the day progresses.

2. Difficulty Swallowing (Dysphagia)

Swallowing difficulties are common in Unilateral Vocal Fold Paralysis because the paralyzed vocal fold cannot fully close off the airway during swallowing. This can lead to:

Choking: Patients may choke on food or liquids, particularly when swallowing.

Coughing: Coughing during or after meals is another common symptom.

Aspiration: In more severe cases, food or liquid can enter the airway (aspiration), which can lead to pneumonia or other respiratory complications.

3. Breathing Difficulties

While less common, some patients with Unilateral Vocal Fold Paralysis may experience breathing difficulties, particularly during strenuous activities. This occurs because the paralyzed vocal fold may partially obstruct the airway.

Diagnosing Unilateral Vocal Fold Paralysis

Diagnosing Unilateral Vocal Fold Paralysis involves a combination of patient history, physical examination, and specialized tests. At the International Voice Clinic, our team of experts uses the latest technology to accurately diagnose this condition and determine the best course of treatment.

Patient History and Physical Examination

The first step in diagnosing Unilateral Vocal Fold Paralysis is a thorough patient history and physical examination. We will ask about your symptoms, when they started, and any possible causes, such as recent surgery or trauma. A physical examination of the neck and throat may also be performed.

Laryngoscopy

Laryngoscopy is a procedure that allows the doctor to visualize the vocal folds. Using a thin, flexible tube through your nose or by a rigid tube through your mouth, with a camera (called laryngoscopes), the doctor can see how the vocal folds move when you speak or breathe. This procedure is easily performed in the office and provides critical information about the extent of the paralysis. The procedure may be defined as videolaryngostroboscopy, flexible fiberoptic laryngoscopy or chip-on-type high-resolution imaging according to the light source and the specific endoscope that is used.

Imaging Studies

Imaging studies, such as a Computerized Tomography scan or Magnetic Resonance Imaging, may be ordered to identify any structural abnormalities, such as tumors or nerve compression, that could be causing the paralysis. These imaging techniques provide detailed pictures of the head, neck, and chest, helping to pinpoint the exact cause of the problem.

Voice Analysis

Voice analysis involves recording and analyzing your voice to assess its quality and strength. This can help the doctor understand how the paralysis is affecting your voice and guide treatment decisions.

Treatment Options for Unilateral Vocal Fold Paralysis

The treatment of Unilateral Vocal Fold Paralysis depends on the severity of the symptoms, the underlying cause, and the impact on the patient’s quality of life. At the International Voice Clinic, we offer a range of treatment options, from voice therapy to surgical interventions, all tailored to meet the individual needs of each patient.

Voice Therapy

Voice therapy is often the first line of treatment for Unilateral Vocal Fold Paralysis, particularly in cases where the paralysis is not causing severe symptoms. Voice therapy involves working with a voice therapist to improve voice quality and function. Techniques used in voice therapy may include:

Vocal Exercises: Exercises designed to strengthen the vocal folds and improve their coordination.

Breathing Techniques: Learning how to control breathing to support the voice and reduce strain on the vocal folds.

Posture and Relaxation: Improving posture and reducing tension in the neck and shoulders can help enhance voice quality.

Voice therapy is particularly effective in cases where the vocal fold paralysis is temporary or where the remaining vocal fold can compensate for the paralyzed fold over time.

Medialization Procedures

Medialization procedures are surgical techniques used to move the paralyzed vocal fold closer to the midline, allowing the functioning vocal fold to meet it more easily. This can improve voice quality, swallowing, and sometimes breathing. Common medialization procedures include:

Injection Laryngoplasty: In this procedure, a substance (such as fat, hyaluronic acid, or calcium hydroxyapatite) is injected into the paralyzed vocal fold. This bulks up the fold, allowing it to move closer to the midline. Injection laryngoplasty may be performed under local or short term general anesthesia and can provide immediate improvement in voice quality. The effects may be temporary or long-lasting, depending on the material used. This procedure may also be defined as filling the vocal cords, vocal cord filling or closed vocal cord surgery.

Thyroplasty: Thyroplasty is a more permanent surgical procedure that involves placing an implant in the larynx to push the paralyzed vocal fold toward the midline. This surgery is typically performed under local anesthesia in the operating room, allowing the surgeon to adjust the implant during the procedure to achieve the best voice outcome.

Arytenoid Adduction: In cases where the vocal fold is severely paralyzed or positioned laterally, arytenoid adduction may be performed. This surgical procedure repositions the arytenoid cartilage, which controls the movement of the vocal folds, to improve vocal fold closure.

Reinnervation Procedures

Reinnervation procedures aim to restore nerve function to the paralyzed vocal fold by connecting a healthy nerve to the damaged recurrent laryngeal nerve. Over time, the healthy nerve can grow into the paralyzed vocal fold, potentially restoring movement and improving voice quality. These procedures are more complex and are typically reserved for patients who are not candidates for other types of surgery or who have not responded to other treatments.

Lifestyle and Dietary Modifications

In addition to medical and surgical treatments, lifestyle and dietary modifications can play an important role in managing the symptoms of UVFP. These modifications may include:

Avoiding Irritants: Avoiding smoking, alcohol, and other irritants can reduce inflammation and improve vocal fold function.

Dietary Changes: Patients with swallowing difficulties may benefit from dietary changes, such as eating softer foods or avoiding foods that are difficult to swallow.

Hydration: Staying well-hydrated is important for maintaining vocal fold health and preventing dryness and irritation.

Recovery and Prognosis

The prognosis for Unilateral Vocal Fold Paralysis varies depending on the underlying cause, the severity of the paralysis, and the treatment used.