Vocal Cord Paralysis

Vocal cord paralysis can affect your voice, swallowing, and even breathing. At Duke Voice Care, our voice specialists use the latest technology to diagnose vocal cord paralysis. We offer voice therapy to reduce the functional impact of vocal cord paralysis and focus treatment on improving speaking, swallowing, and/or breathing.

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About Vocal Cord Paralysis

Vocal cord paralysis can occur when the nerve responsible for your vocal cord movement is damaged, preventing one or both of your vocal cords (also known as vocal folds) from opening and closing properly. This can be due to trauma, surgical injury, stroke, a virus, or a tumor. Sometimes the cause of a vocal cord paralysis is unknown; this is called “idiopathic vocal paralysis.”

Depending on the extent and functional impact of the paralysis, you may have a breathy, weak, and/or soft voice, as well as changes in swallowing and breathing. In rare cases where both vocal cords are paralyzed, you can have difficulty with breathing and/or swallowing that requires immediate medical attention.

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Treatments for Vocal Cord Paralysis

Voice Therapy

In some cases of vocal cord paralysis, voice quality can be improved with voice therapy alone. It is important to learn how to best use your entire vocal instrument. That means using breath effectively while relaxing your throat to achieve your best voice. Our specially trained speech pathologists will tailor your therapy to treat your specific voice problems.

Vocal Cord Injection

Injectable fillers add bulk to vocal cords that have lost muscle tone or cannot close well due to vocal cord paralysis. The filler is injected through a tiny needle into the area near one or both vocal cords. The injection helps the vocal cords close better, creating a stronger voice. This procedure can be done in an operating room or during an outpatient clinic visit, depending on the type of material used and your preference. The results from the injection can last anywhere from two to three months to about a year, again depending on the type of material used. Sometimes repeat injections or another type of procedure are needed.

Thyroplasty

An implant (like a tiny shim) is placed through the outside of the voice box to reposition the paralyzed vocal cord and produce a stronger voice. This procedure requires a small incision in the neck and is performed in an operating room under sedation. Thyroplasty may be recommended if your vocal cord paralysis appears permanent and your voice is weak and breathy. We recommended starting with a temporary vocal cord injection to see if you like the results before opting for the permanent procedure.

Arytenoid Adduction

This procedure is sometimes used in combination with thyroplasty. It corrects the position of the vocal cord to achieve better vocal cord closure and a stronger voice.

Laryngeal Nerve Reinnervation

This surgical procedure connects a nerve to the weakened vocal cord muscle. It is performed in the operating room under general anesthesia. This restores the vocal cord's tone and bulk, which makes the voice stronger. Full results can take two to six months.

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Tests for Vocal Cord Paralysis

We will perform a comprehensive voice evaluation to assess your voice use patterns -- how much you speak, sing, or use a loud voice, and how your voice sounds. With vocal cord paralysis, your team is listening carefully to hear if you have a weak or breathy voice, have difficulty being loud, or get tired with speaking. Your laryngologist will evaluate the role of any medical conditions that can cause voice changes, such as surgeries or recent illnesses. We will perform a head and neck examination and a visual examination of your voice box. Your team will also ask about difficulties with swallowing. Further testing may be recommended.

Videolaryngostroboscopy

Videolaryngostroboscopy is the gold standard for vocal cord and voice box evaluation. This test is typically only available at ear, nose, and throat (ENT) clinics that specialize in voice disorders, like those at Duke.

This detailed visual exam enables your provider to observe how your vocal cords vibrate while you speak or sing and to look for lesions, stiffness, paralysis, irregular movements, throat strain, incomplete closure of the vocal cords, or other physical contributors to your voice, swallowing, and/or breathing problem.

A tiny camera attached to a small tube called an endoscope is inserted through your nose, allowing your provider to see your vocal cords and larynx (voice box). The camera records while a flashing strobe light simulates slow motion video capture of your vocal cords moving. Compared to a still photo, this video allows your provider to see subtle changes in how your voice box and throat function when you make different sounds. It takes only about a minute, and your nose may be sprayed with topical anesthetic to numb and open the nasal passages to make it more comfortable for you. After the exam, your team will review the recording with you to determine an accurate diagnosis and treatment plan.

Swallowing Evaluations

People with vocal cord paralysis may have trouble protecting their airway during swallowing. Your laryngologist may order a swallow study to ensure no food or liquid enter your airway.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
A flexible endoscope (a small tube with a camera and light) is passed through your nose to view your throat while you swallow brightly colored foods and liquids. You may be asked to try different swallowing positions, such as tilting your head or tucking your chin, to see which work best.
Videofluoroscopic Swallow Study (VFSS)
This exam makes an X-ray video of your mouth, throat, and upper esophagus as you swallow foods and drinks of different textures and consistencies mixed with barium. Barium is a substance that is visible on X-rays and allows your providers to see exactly where food and liquid go when you swallow. We evaluate your swallowing process, whether food or liquid is entering your airway (aspiration), which types and consistencies of food and liquid are safest for you to swallow, and what strategies may make it easier for you to eat and drink safely.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2025–2026.

Why Choose Duke

Team of Voice Experts
You'll have access to one of the few comprehensive voice care programs in the Southeast and its team of voice experts. Your care team will include laryngologists -- ENT doctors with advanced training in voice disorders -- and highly specialized speech pathologists. We treat all laryngeal conditions, including voice problems, upper airway breathing problems, and swallowing disorders -- all of which may be affected by vocal cord paralysis.

Highly Trained ENT Surgeons
If surgery is needed, our ENT surgeons have the advanced training and expertise to offer a full range of surgical options for vocal cord paralysis.

Specialty Care for Singers and Professional Voice Performers
Our trained singing voice specialists provide specialized therapy to performers and singers. They are experienced performers, singers, and singing teachers who bring empathy, clinical expertise, and an insider's perspective to improving the vocal health of singers and other vocal performers.

Coordinated Care
If you have other medical conditions that may contribute to difficulty with your voice, breathing, or swallowing, we will work with other providers throughout Duke Health to ensure you receive the best care from a comprehensive team.

This page was medically reviewed on 02/24/2025 by

Meghan Esper, CCC-SLP, MA | Speech Pathologist