What is Vocal Fold Paralysis?

To better make sense of vocal fold paralysis, let us first get the hang of the vocal process—how we, humans, produce the most natural of all musical instruments, the voice. Our voice is a sound produced by the vibration of air as it goes through the vocal folds, a pair of smooth muscle tissues arranged in strips opposing each other. Imagine the edges of a clam meat, now that resembles a pair of closed vocal folds. This melodic pair is located at the base of the tongue (and our tongue, by the way, is way more larger than what we see from the outside!) and above the windpipe, the passageway to the lungs.

Let us not forget the mighty brain that sends nerve impulses to our vocal folds, governing the vocal process. After all, it is the brain that relays messages as to what or when to speak or sing, or basically when to use our voice. Vocal fold paralysis is the disruption of the nerve impulses coming from the brain towards the vocal folds, paralyzing them, and consequently causing the inability to articulate sounds.

Signs and symptoms of vocal fold paralysis consist of: Loss of the gag or swallow reflex; unproductive cough, or cough that does not really help in clearing the throat; increased frequency of throat clearing and/or breathing while speaking; loss of pitch and decreased volume of speech; choking or coughing while swallowing edible substances or saliva; breathy and whispery voice; and noisy breathing. 

Possible causes include neurological conditions such as Parkinson’s disease or stroke, which arrest the mechanism of the nervous system, primarily in relaying impulses and “messages” from the brain to the different muscles. (Remember, our vocal folds are muscles too!) Viral infections: Herpes, Lyme disease, etc., can inflame and damage our vocal folds as well. Tumors—benign and malignant alike—may also grow on the structures of the vocal folds and paralyze them. Another cause would be surgeries of the neck and upper chest that may injure the vocal nerves. Furthermore, since we are now getting the idea that anything which disables the vocal nerves also debilitates our vocal folds, any physical trauma or injury that damages those nerves may also be a precursor to vocal fold paralysis.

Complications of vocal fold paralysis may not only be limited to speech problems, but may also compromise breathing, as our vocal folds are on top of the windpipe and are therefore part of the passageway of air. It can range from mild breathing issues such as shortness of breath and noisy breathing, to life-threatening deprivation of oxygen!

In diagnosing vocal fold paralysis, doctors utilize various procedures such as laryngoscopy, laryngeal electromyography, and blood tests and scans. In laryngoscopy, the doctor views the vocal folds through a thin mirror or a flexible tube known as an endoscope. Endoscopes are connected to a monitor that allows the doctor to observe the vocal folds in a magnified perspective. Electromyographies refer to the use of special needles inserted into the neck of the patient, which allow the detection of impulses in the vocal muscles.

By virtue of varying causes for vocal fold paralysis, treatment methods also vary depending on the cause, affected structure, and severity of the disease. Surgery, speech and language therapy or voice therapy, or a combination of these may be indicated. In mild cases, there is no need for surgery and the doctor may advise the patient to just wait it out and delay surgery as the nerves heal. Speech and language pathologists employ exercises to strengthen the vocal folds; proper control of breathing; and practice of speech. If surgery is required, one’s vocal folds may be injected with collagen or fat, or subjected to implant and repositioning of tissues. The goal of those three methods is to bring the paralyzed vocal folds closer so they can vibrate against each other and regain functionality. Lastly, replacing the disabled nerve with a healthy nerve from a nearby site at the neck can also be done.

 Do not hesitate to consult your doctor whenever you are persistently experiencing symptoms mentioned earlier. The doctor may refer you to a speech-language pathology or otolaryngologist so as to prevent or intervene with what could be vocal fold paralysis!