Your vocal cords are two flexible bands of muscle tissue that sit at the entrance to the windpipe (trachea). When you speak, the bands come together and vibrate to make sound. The rest of the time, the vocal cords are relaxed in an open position, so you can breathe.
In most cases of vocal cord paralysis, only one vocal cord is paralyzed. If both of your vocal cords are affected, you may have vocal difficulties, as well as significant problems with breathing and swallowing.
Signs and symptoms of vocal cord paralysis may include:
- A breathy quality to the voice
- Noisy breathing
- Loss of vocal pitch
- Choking or coughing while swallowing food, drink or saliva
- The need to take frequent breaths while speaking
- Inability to speak loudly
- Loss of your gag reflex
- Ineffective coughing
- Frequent throat clearing
When to see a doctor
If you have unexplained, persistent hoarseness for more than three or four weeks, or if you notice any unexplained voice changes or discomfort, contact your doctor.
In vocal cord paralysis, the nerve impulses to your voice box (larynx) are disrupted, resulting in paralysis of the muscle. Doctors often don't know the cause of vocal cord paralysis. Known causes may include:
- Injury to the vocal cord during surgery. Surgery on or near your neck or upper chest can result in damage to the nerves that serve your voice box. Surgeries that carry a risk of damage include surgeries to the thyroid or parathyroid glands, esophagus, neck, and chest.
- Neck or chest injury. Trauma to your neck or chest may injure the nerves that serve your vocal cords or the voice box itself.
- Stroke. A stroke interrupts blood flow in your brain and may damage the part of your brain that sends messages to the voice box.
- Tumors. Tumors, both cancerous and noncancerous, can grow in or around the muscles, cartilages or nerves of your voice box and can cause vocal cord paralysis.
- Inflammation. Arthritis or surgery can cause inflammation and scarring of the vocal cord joints or the space between the two vocal cord cartilages, and this inflammation may prevent your vocal cords from opening and closing. The symptoms and signs of this disorder mimic vocal cord paralysis, even though the vocal cord nerves remain normal. In addition, some viral infections can cause inflammation and damage directly to the nerves in the larynx.
- Neurological conditions. If you have certain neurological conditions, such as multiple sclerosis or Parkinson's disease, you may experience vocal cord paralysis.
Factors that may increase your risk of developing vocal cord paralysis include:
- Being female. Women are slightly more likely to develop vocal cord paralysis.
- Undergoing throat or chest surgery. People who need surgery on their thyroid, throat or upper chest have an increased risk of vocal cord nerve damage. Sometimes breathing tubes used in surgery or to help you breathe if you're having serious respiratory trouble can damage the vocal cord nerves.
- Having a neurological condition. People with certain neurological conditions — such as Parkinson's disease, multiple sclerosis or myasthenia gravis — are more likely to develop vocal cord weakness or paralysis.
Breathing problems associated with vocal cord paralysis may be so mild that you just have a hoarse-sounding voice, or they can be so serious that they're life-threatening. Because vocal cord paralysis keeps the opening to the airway from completely opening or closing, other complications may include choking on or actually inhaling (aspirating) food or liquid. Aspiration that leads to severe pneumonia is very serious and requires immediate medical care.