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    Voice Disorders - Vocal Fold Paralysis

    Overview
    Causes
    Symptoms
    Diagnosis
    Treatment
    Where To Seek Treatment
    Singapore General Hospital
    Contributed by Dept of Otolaryngology
    Singapore General Hospital

    Overview

    Vocal fold paralysis is less common than the first two groups of disorders. It usually involves paralysis of one vocal fold, and results in inability to close the vocal folds completely. If the vocal folds do not close completely, the voice is weak and hoarse and there may be choking on swallowing due to food or liquids going into the windpipe.


    Causes

    • Tumours pressing on the nerve that controls vocal fold movement (e.g. cancers of the thyroid, lung, esophagus and nasopharynx).
    • Injury of the nerve that controls vocal fold movement (e.g. during thyroid and chest surgeries; following radiation therapy to the neck; or neck injury).
    • Neurologic conditions such as a stroke.

    Symptoms

    • Hoarse voice
    • Weak, breathy voice
    • Loss of pitch control
    • Choking or coughing especially on drinking liquids

    Diagnosis

    As with other voice disorders, examination of the vocal folds with nasoendoscopy or videostroboscopy may be required (see page 38). Other investigations may include CT or MRI scanning to look for the cause of the paralysis. The specialist may also discuss transnasal oesophagoscopy to examine the food passage (this can be carried out in the clinic); and laryngeal electromyography, which uses a fine needle to measure function of the vocal fold muscle.


    Treatment

    Sometimes recovery occurs by itself and no action is needed. Depending on the cause of paralysis this may take up to a year. While waiting for the nerve to recover, speech therapy or an injection to bulk up the paralysed vocal fold may be helpful. Sometimes an operation (medialisation thyroplasty) is needed to permanently shift the paralysed vocal fold to improve the voice. This operation can be carried out under local anaesthetic and the specialist will discuss the options with you.

    Rarely, if the paralysis involves both vocal folds, there can be difficulty breathing or noisy breathing due to narrowing of the airway. In this situation, a surgical procedure called a tracheostomy may be needed. This involves placing a breathing tube (known as a tracheostomy tube) through an opening in the windpipe. Sometimes a laser procedure to widen the airway may be used instead.

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