Vocal cord paralysis is a voice disorder that occurs when one or both of the vocal cords (or vocal folds) do not open or close properly. Vocal fold paresis/paralysis can happen at any age – from birth to advanced age, in males and females alike, from a variety of causes. Vocal cord paralysis is a common disorder, particularly among the elderly, and symptoms can range from mild to life threatening. The vocal cords are two elastic bands of muscle tissue located in the larynx (voice box) directly above the trachea (windpipe).   

The most common symptoms of vocal cord paralysis or paresis include hoarseness, vocal fatigue, pain for tightness in the throat when speaking, aspiration, and breathing difficulties.  People with one paralyzed vocal cord often complain of choking when drinking liquids, but they rarely have difficulty swallowing foods.

Vocal cord paralysis can result from injury, tumors, or surgery in the neck and upper chest. There are several locations in the central nervous system including the nucleus ambiguus, the supranuclear tracts, the main trunk of the vagus nerve, or the recurrent laryngeal nerves, when injured or compressed by a tumor, may cause vocal cord paralysis.  The cause of vocal cord paralysis may indicate whether the disorder is permanent, or likely to improve over time.

One of the most important things to distinguish from vocal cord paresis/paralysis is vocal cord fixation. Someone who has vocal cord paralysis often has difficulty swallowing and coughing because food or liquids slip into the trachea and lungs. This happens because the paralyzed cord or cords remain open, leaving the airway passage and the lungs unprotected. During swallowing, the vocal cords shut the airway so that food is not inhaled. When vocal cords are paralyzed, all three functions are affected. The most dangerous form of vocal cord paralysis is one that affects the opening function, controlled by the recurrent laryngeal nerve. Treatments for vocal cord paralysis range from voice therapy to help you strengthen your vocal cords and improve your ability to speak, to surgical options, or both.

The common causes and risk factor's of vocal cord paralysis include the following: a viral infection, thyroid or lung cancer, a neurologic insult such as a stroke, or exposure to smoking.  Tumors, both cancerous and non-cancerous, can grow around the muscle and cartilage of the voice box, causing paralysis.  Certain neurologic conditions, such as Parkinson's disease or multiple sclerosis may also cause vocal cord paralysis.  There are certain endocrine diseases which contribute to vocal cord problems.

Symptoms of vocal cord paralysis include the following: discomfort from vocal straining,  changes in voice quality, such as loss of volume or pitch, shortness of breath with exertion, ineffective or poor cough, noisy breathing, inability to speak loudly, and the inability to "bear down" while lifting.

There are several methods for the treatment of vocal cord paralysis.  Voice therapy is often a first treatment option, especially if the cause of the condition is unknown.  Botanical medicine and deep tissue massage to the area can bring some improvement, although temporary.  Sometimes, an operation that permanently shifts a paralyzed vocal cord closer to the center of the airway may improve the voice. An adequate airway is always necessary, sometimes requiring an endotracheal tube in the windpipe, and sometimes requiring a tracheostomy (a surgical procedure to create an opening into the trachea through the neck).