Vocal Cord Paralysis, Treatment, Surgery

What is vocal cord paralysis?

Vocal cord paresis and paralysis result from abnormal nerve input to the voice box muscles (laryngeal muscles)
Paralysis is the total interruption of nerve impulse, resulting in no movement
Paresis is the partial interruption of nerve impulse, resulting in weak or abnormal motion of laryngeal muscles. Paresis/paralysis can happen at any age, from birth to advanced age, in males and females, from a variety of causes
The effect on patients may vary greatly, depending on the patient’s use of his or her voice: A mild vocal fold paresis can be the end to a singer’s career, but have only a marginal effect on a other people

The cause of vocal fold paralysis or paresis can indicate whether the disorder will resolve over time or whether it may be permanent
When a reversible cause is present, surgical treatment is not usually recommended, given the likelihood of spontaneous resolution of the problem
Despite advances in diagnostic technology, physicians are unable to detect the cause in about half of all vocal fold paralyses, referred to as idiopathic (due to unknown origins)
In these cases, paralysis or paresis might be due to a viral infection affecting the voice box nerves (RLN or SLN), or the vagus nerve, but this cannot be proven in most cases

Speech therapy for patients with vocal cord paralysis usually focuses on pitch alteration, increasing breath support and loudness
Finding the correct position for optimal voicing (such as turning the head to one side or manipulating the thyroid cartilage) is very helpful – this is known as the Isshiki maneuver
Research has shown that voice therapy is an effective intervention in the interim period between diagnosis of the paralysis and final resolution of the problem

A thyroplasty is a surgical procedure in which a paralysed or weak vocal cord is moved closer to the centre of the voice box
Thyroplasty aims to help people with a paralysed vocal cord by;
- Improving the voice
- Lower the chance of food and drink going down the windpipe during eating and drinking
This is accomplished by injecting a small amount of silicone into the paralysed vocal cord

The following advice sheet will help you plan for a comfortable recovery period after surgery for vocal cord paralysis

The throat is usually a bit sore for a few days to a week post-operatively; we recommend starting out with a fluid diet or soft foods after the procedure
You may advance your diet as quickly as you feel comfortable
You can even eat your favourite foods the day after surgery if your throat feels alright
Most people will take a few days to feel better

Limited voice use for a week post-operatively – this means necessary voice use only
- Reduced use of the voice will help post-operative swelling in the vocal cord resolve
If a longer period of voice limitation is necessary your surgeon will discuss that with you at the one-week follow-up visit
No heavy lifting or strenuous activity for six weeks after the surgery