Vocal Cord Paralysis: Treatment, Cost and Side Effects

Vocal cord paralysis is caused by abnormal nerve stimuli to the voice box muscles which results in paralysis or paresis. In the case of Paralysis, the muscles stop receiving any further nerve stimulus and thus make no movement. In the case of paresis there is partial disruption of nerve stimulus due which though the muscles move, they either have weak or abnormal movement. Vocal cord paresis can happen at any time and any stage of life due to a variety of causes like trauma to the larynx, thyroid diseases, viral infections, systemic neurologic diseases, etc. Sometimes it may also happen due to conditions present at birth like hydrocephalus, Arnold – Chiari malformation, etc.

Vocal cord paralysis/paresis can occur in two different nerves - superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN). The SLN provides stimuli to the cricothyroid muscle. This muscle is responsible for adjusting the tension of the vocal fold. SLN paresis and paralysis causes abnormalities in voice pitch due to malfunctioning of the cricothyroid.

The RLN provides stimuli to voice box muscles that control opening and closing of vocal folds. Thus essential functions like swallowing, breathing etc. may get impacted in case of paralysis of RLN. The RLN is comparatively longer and makes a round trip to the larynx through the chest. Therefore it can be damaged by complications during surgery in the head, neck, or chest and hence RLN is the cause of majority of cases of vocal cord paresis/paralysis. The treatment for Vocal cord paralysis/ paresis is categorized under two heads – Voice therapy and surgical intervention and is aimed at improving the functioning of the vocal folds. The treatment to be done depends primarily on the cause of the vocal cord paralysis

Usually voice therapies are the first stage of treatment and usually used in case of vocal cord paresis. Voice therapies are aimed at improving the functioning of the larynx muscles and narrowing of the glottis so as to align the paralyzed vocal folds with the functional folds. These therapy session teach breathing exercises like diaphragmatic breathing, hard glottal attacks, half swallow booms, etc. The patient condition is monitored during the voice therapy and for a year after it. If there are no significant improvements during this period, then the treatment proceeds to the next stage that is - surgery.

Surgery is generally done in case of full paralysis of vocal cords or when voice therapies do not have result in any significant improvement. Since vocal cord paralysis causes considerable problem in breathing, surgeries usually have an aim of widening the airway. Usually surgeries are performed through either of these techniques – Tracheostomy, Artenoidectomy, Cordotomy. In case of Tracheostomy a direct incision is made in the neck and a hollow tube is inserted into the trachea to facilitate breathing. In Artenoidectomy, the Aryetenoid cartilage in the glottis is surgically removed to widen the opening of the glottis. Whereas in Cordotomy, tissues from the vocal folds, vocal ligaments or the Thyroartenoid muscles are surgically excised to widen the opening of glottis. Sometimes the paralyzed nerves recover functioning. In such cases where there is chance of reinnervation usually voice therapy or in case of extreme difficulty in breathing, tracheostomy is usually done.

While you can immediately start with voice therapy once diagnosed with vocal cord paralysis, in case of surgery the doctor needs to be consulted. In case you have severe breathing problems the doctor may suggest surgeries immediately. However, if that is not the case they usually recommend voice therapy and monitor your condition for a year or so after that. Based on observations they may suggest surgery later.

While everybody can go for voice therapies, you may have to consult with doctors if you have a history of bleeding disorders or complications due to general anesthesia

While voice therapies do not have any side effects as they involve only simple vocal exercise, in surgeries there can be general complications like infection, damage to surrounding nerves, etc. Some complications that can occur specifically in tracheostomy are : 1. Damage to esophagus tube 2. Air being trapped inside the lungs or the inner layers of the chest or around the skin layers of tracheostomy tube. In severe case of these scenarios one may have to go for additional surgical treatments 3. The trachea tissues may get damaged from continuous friction with the tube 4. If tracheostomy tubes are being used for a long time, the esophagus and trachea may connect together. This condition is known as tracheoesophageal fistula and may need further resections and surgical treatments

Voice therapy specialist often suggest the required exercise and instruction that you should follow post therapy. In case of tracheostomy, you may require to relearn speaking because when you exhale, the air instead of passing over the vocal cords, passes out through the tracheostomy tube. You should get the tracheostomy tubes regularly cleaned and replaced at the hospitals. Unless the doctor has given instructions on how to change or clean the tubes you should not try to do them at home. Rather, visit the hospitals to get them changed or cleaned. Additionally, in case of all surgeries until your wounds heal, avoid eating solid food.

while voice therapy does not require any recovery time, surgeries like tracheostomy may require 3-4 weeks.

The cost of treatment depends on whether it is voice therapy or a surgery and is in the range of Rs. 56,000 – Rs. 84,000

While in case of the surgeries the results are permanent in nature due to surgical modifications, in case of voice therapy the effectiveness mostly depends on how well the patient practices the vocal exercises prescribed. In case, these are not done properly, problems may resurface again.

The type of treatment is decided mostly by the cause and can be either voice therapy or surgery or in certain cases both. However, alternative treatments like injection medialization, reinnervation techniques also exist apart from these two .