The most common neurological condition that affects the larynx is a paralysis or weakness of one or both vocal folds, resulting from problems between the nerves and muscles in the larynx (voice box).

It is rare for both vocal folds to be affected, and, in this case, the primary concern is difficulty breathing.

More commonly, when one vocal fold is paralyzed or weak, the voice is usually the problem rather than breathing. One vocal fold can become paralyzed (immobile), or weakened (paresis) from a viral infection of the throat after surgery to the neck or chest, from a tumor or growth along the laryngeal nerves, or for unknown reasons.

Vocal fold paralysis typically presents with a soft and breathy voice. Many cases of vocal cord paralysis will resolve within several months. In some cases, however, the paralysis will be permanent and may require intervention to improve the voice.

In addition, swallowing can be impaired with a vocal fold paralysis, and surgery may be needed to protect the airway and prevent aspiration.

Treatment

Treatment depends on the nature of the vocal fold paralysis, degree of vocal impairment, and the patient’s vocal needs, and may involve voice therapy and/or surgery.

While surgery cannot restore movement to paralyzed vocal folds, there are good surgical options for improving the voice. In cases of unilateral vocal fold paralysis, surgery can reposition or “bulk up” the vocal fold to improve contact between the two vocal folds and improve their vibration.

A variety of surgical techniques can be used to accomplish this, including:

• OR-based augmentation
• Office-based augmentation
• Thyroplasty

Voice therapy can also be helpful to maximize vocal quality after these surgeries.