What is this Condition?

Vocal cord paralysis is caused by disease of or injury to one of the nerves that conduct impulses to and from the vocal cord muscles.

What Causes it?

Vocal cord paralysis commonly is caused by accidental severing of a nerve during thyroid surgery. Other causes include pressure from an aortic aneurysm or from an enlarged lower heart chamber (in people with a congenital heart disorder called mitral stenosis), bronchial or esophageal cancer, enlargement of the thyroid gland, neck injuries, or intubation. Paralysis may also be caused by neuritis from infections or metallic poisoning, or from hysteria.

What are its Symptoms?

One-sided paralysis, the most common form, may cause vocal weakness and hoarseness. Paralysis on both sides typically causes vocal weakness and incapacitating airway obstruction if the cords become paralyzed in the adducted position.

How is it Diagnosed?

The doctor makes a diagnosis of vocal cord paralysis based on a person’s history and symptoms. Diagnosis may be confirmed by a test called indirect laryngoscopy. This test shows one or both cords fixed in an adducted or partially abducted position.

How is it Treated?

Treatment of one-sided vocal cord paralysis consists of injecting Teflon into the paralyzed vocal cord, under direct laryngoscopy. This procedure enlarges the vocal cord and brings it closer to the other cord, which usually strengthens the voice and protects the airway from aspiration.

In another procedure, an implant is placed through a neck incision. The implant helps establish nerve control of the vocal cord muscles. If a person has bilateral cord paralysis, with the cords pulled toward the center position, he or she may have to undergo tracheotomy.

What are these Conditions?

Nodules and polyps are types of benign growths that may appear on the vocal cords. Both nodules and polyps have good prognoses, un­less continued voice abuse causes recurrence, with subsequent scarring and permanent hoarseness.

What Causes them?

Vocal cord nodules and polyps usually result from voice abuse, especially in the presence of infection. Consequently, they’re most common in teachers, singers, and sports fans, and in energetic children (ages 8 to 12) who continually shout while playing. Polyps are common in adults who smoke, live in dry climates, or have allergies.

What are their Symptoms?

Nodules and polyps inhibit the movement of the vocal cords and produce painless hoarseness. The voice may also sound breathy or husky.

How are they Diagnosed?

If a person has persistent hoarseness, the doctor may suspect vocal cord nodules and polyps. To confirm the diagnosis, the vocal cords may be visualized using a test called indirect laryngoscopey. In a person with vocal cord nodules, laryngoscopy initially shows small red nodes; later, white solid nodes will be seen on one or both cords. In a person with polyps, laryngoscopy reveals polyps of varying size, which may appear anywhere on the vocal cords and may occur on one or both cords.

How are they Treated?

Conservative management of small vocal cord nodules and polyps includes humidification, speech therapy (voice rest, training to reduce the intensity and duration of voice production), and treatment of any underlying allergies.

When conservative treatment fails to relieve hoarseness, the doctor will remove nodules or polyps under direct laryngoscopy. The doctor may use microlaryngoscopy for small lesions to avoid injuring the vocal cord surface.

If nodules or polyps are present on both cords, surgical removal may be performed in two stages so that one cord can heal before polyps are removed from the other cord.

For children, treatment consists of speech therapy. If possible, surgery should be delayed until the child is old enough to benefit from voice training, or until he or she can understand the need to abstain from voice abuse.

A growth on the larynx may be either benign (unlikely to spread), or malignant (likely tospread and threaten life). There are two types of benign tumors of the larynx: papillomas, which usually appear several at a time; and polyps, which usually appear one at a time. Both types usually can be removed without permanent ill-effects. They seem to be caused by misuse or over use of the vocal cords. Malignant tumors occur most often in people who smoke heavily.

What are the Symptoms?

Hoarseness is usually the only symptom of a tumor is lowing difficult, and you may have an increasingly obvious lump in your neck. In a child, because the airway through the larynx is narrow, a tumor of the larynx may give the voice a high-pitched crowing sound, known as stridor , because of the obstruction.

Hoarseness that is caused by benign growths is usually intermittent, but hoarseness due to cancer is continuous and gradually worsens. Since it is not painful and comes on slowly, you may scarcely notice it during its early stages.

What are the Risks?

Although neither type of tumor of the larynx is very common, benign tumors are slightly less common than malignant ones. The American Cancer Society estimates that there are about 11,000 new cases of cancer of the larynx each year, and that about 9,000 of those affected will be men.

The main risk is that if you ignore slowly increasing hoarseness, and if that hoarseness is caused by a malignant tumor, it may be too late to deal successfully with the cancer. Cancer of the larynx can almost always be cured if it is diagnosed early. If it is not discovered in time, it can either spread to other parts of the throat or get into the blood stream and produce metastases, or secondary cancers, elsewhere in your body.

What Should be Done?

Do not ignore unexpected vocal changes. If you remain hoarse for more than a week, or if hoarseness keeps coming back, consult your physician. If your throat shows no signs of the inflammation that accompanies laryngitis, the physician may refer you to an ear, nose and throat specialist, who will examine your larynx by reflecting a light from a mirror held at the back of the throat. If there is swelling or any other sign of a growth, the specialist will probably do an endoscopic examination, and a biopsy, which determine whether you have a tumor and, if so, whether it is malignant.

What is the Treatment?

Self-help: No self-help is possible.

Professional help: Benign growths, whether papillomas or polyps, can usually be removed in a minor operation done under local anesthetic. Malignant tumors discovered early are generally treated, and in most cases cured, by radiation therapy. If the cancer is more advanced, the larynx may have to be removed. Even then there is about an even chance of cure. To regain your voice, however, you will have to work with a speech therapist, who may teach you how to use the esophagus as a substitute for the larynx. An alternative technique involves implanting an artificial valve between the esophagus and the trachea. The valve permits air to move out of the lungs, through the valve, and up the esophagus, where you produce the sounds used in speech.