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Vocal cord paralysis
|Disease:||Vocal cord paralysis|
|Category:||Ear, nose, larynx diseases|
Lots of aspects of a person’s life could be affected by vocal cord paralysis. Other than producing sounds, the vocal cords protect the airway be preventing food and drink from entering the windpipe also called trachea and causing the person to choke. This condition could be life-threatening in some rare cases. The person won’t be able to breathe properly in case both of the cords are paralyzed in the closed position because it will reduce the flow of air into the lungs. On the other hand, the person’s voice will be weak or hoarse in case the vocal cord is paralyzed in an open position. If the nerves that control the vocal cords are intentionally or accidentally damaged, such as after neck or throat surgery, vocal cord paralysis may occur. Vocal cord paralysis could also result from thyroid cancers or lung tumors.
Located at the entrance to the windpipe, the vocal cords are two flexible bands of muscle tissue. These bands come together and vibrate to make sound when a person speaks. The vocal cords are relaxed in an open position the rest of the time so that the person can breathe. Mostly only one vocal cord is paralyzed. Depending on the paralyzed position of the vocal cord, signs and symptoms might include:
A person might experience the signs and symptoms mentioned above as well as significant problems with breathing in case both of the vocal cords are affected.
The nerve impulses to the voice box (larynx) are interrupted in vocal cord paralysis, resulting in paralysis of the muscle. In as many as half the cases, the cause of vocal cord paralysis couldn’t be determined. Causes that are known might include the following:
A stroke might damage the section of the brain that sends messages to the voice box because it interrupts blood flow in the brain.
Both cancerous and noncancerous tumors could develop around the muscles, cartilages or nerves of the voice box, resulting in the paralysis of the vocal cord.
Neck or Chest Injury:
The nerves that serve the vocal cords or the voice box itself could be damaged as a result of trauma to the neck or chest.
A person might experience vocal cord paralysis in the case of having certain neurological conditions, such as multiple sclerosis. Yet, these conditions are more likely to result in vocal cord weakness than complete paralysis.
Inflammation and scarring of the vocal cord joints or the space between two vocal cord cartilages could be caused by arthritis or surgery, which could prevent the vocal cords from opening and closing. although the vocal cord nerves stay normal in this condition, but the signs and symptoms mimic those of vocal cord paralysis. Additionally, the nerves in the larynx could be damaged or become inflamed due to some viral infections.
Injury to the vocal cord during surgery:
Damage to the nerves serving the voice box could be caused by surgery on or near the neck or upper chest. Surgeries to the thyroid, esophagus, neck and chest are surgeries that carry a risk of damage.
Breathing problems linked to vocal cord paralysis could range from mild to life-threatening. Choking on or actually inhaling (aspirating) food or liquid are some of the complications that result from vocal cord paralysis because this condition prevents the opening to the airway from completely opening or closing. Severe pneumonia may result from aspiration.
Voice therapy, surgery or both might be included in the treatment of this condition. For example, the nerve paralysis may return to normal without any surgical treatment. Because of this, surgery might be delayed up to a year and voice therapy might be advised to keep the person from using their voice improperly while the nerves heal. Treatment of vocal cord paralysis depends on the source, the severity of symptoms and the time from the onset of symptoms.
Improving breath control during speech, strengthening the vocal cords, protecting the airway during swallowing and preventing abnormal tension in other muscles around the paralyzed vocal cord are some of the things that the exercises and other activities of voice therapy aim at.
The person’s ability to speak and to swallow can be improved with surgical treatment. Some of the available surgical options are:
Vocal cord repositioning:
In order to make the vocal cord vibrate better against the unimpaired vocal cord, the surgeon will move a “window” of tissue from the outside of the voice box inward, pushing the paralyzed vocal cord toward the middle of the voice box.
A doctor specialized in ear, nose and throat disorders (otolaryngologist) injects the vocal cord with a substance like body fat, collagen or another approved substance in order to add bulk to the paralyzed vocal cord. To enable the functioning, moving vocal cord make closer contact with the paralyzed cord when the person speaks or swallows, this added bulk brings the affected vocal cord closer to the middle of the voice box.
The person may have difficulty breathing and need a surgical operation named a tracheotomy in case both of his/her vocal cords are paralyzed in a closed position. In a tracheotomy, an incision is made in the front of the neck and an opening created directly into the windpipe (trachea). In order to allow air to bypass the immobilized vocal cords above, a breathing tube will be inserted.
The ability of the vocal cords to open and close can be restored by connecting the vocal cords to an alternative source of electrical stimulation, such as a device similar to a cardiac pacemaker or a nerve from another part of the body. Researches keep studying this and other alternatives.
Dr. Samer Al-Jneidy
Dr. Faisal Dibsi
Dr. Tahsin Martini
Dr . Dirar Abboud
Dr. Hani Najjar
Yaser Habrawi , F.R.C.S.Ed
Samir Moussa M.D.
Dr. Talal Sabouni