Vocal cord paralysis can occur when the nerve responsible for your vocal cord movement is damaged, preventing one or both of your vocal cords from opening and closing properly. This can be due to trauma, surgical injury, stroke, a virus, or a tumor. 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 that requires immediate medical attention.
Vocal cord (also known as vocal fold) 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 recommend the most appropriate treatment to improve the functional impact that vocal cord paralysis may have on your breathing, swallowing, and speaking as quickly as possible.
About Vocal Cord Paralysis
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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.
This detailed visual exam helps us evaluate how your vocal cords vibrate while you make sounds. A tiny camera attached to a small tube called an endoscope is inserted through your nose and into your throat, which allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow-motion video images of your vocal cords. The exam takes only about a minute, and your nose may be sprayed with topical anesthetic for your comfort.
The exam allows us to look for any lesions, stiffness, paralysis, irregular movements, throat strain, or incomplete closure of the vocal cords. Videolaryngostroboscopy is essential to reach an accurate diagnosis and determine the best treatment approach for you.
Fiberoptic Endoscopic Evaluation of Swallowing
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
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 (a liquid visible on X-rays). It evaluates 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 safely.
A barium liquid is swallowed and travels the length of your esophagus. X-ray images are taken while the liquid passes through your esophagus to show problems such as narrowing and other concerns such as how food and liquid travel through your esophagus.
Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again 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 2023–2024.
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 -- ear, nose, and throat (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.
If you have other medical conditions that may contribute to difficulty with your voice or swallowing, we will work with other providers throughout Duke Health to ensure you receive the best care from an integrated team.
Access to the Latest Research
Our ongoing research ensures you receive the best, most up-to-date care for your vocal cord paralysis.