Home      Discussion      Topics      Dictionary      Almanac
Signup       Login
Vocal cord paresis

Vocal cord paresis

Discussion
Ask a question about 'Vocal cord paresis'
Start a new discussion about 'Vocal cord paresis'
Answer questions from other users
Full Discussion Forum
 
Encyclopedia
Vocal cord paresis is weakness of one or both vocal folds
Vocal folds
The vocal folds, also known commonly as vocal cords, are composed of twin infoldings of mucous membrane stretched horizontally across the larynx...

. Symptoms of paresis
Paresis
Paresis is a condition typified by partial loss of voluntary movement or by impaired movement. When used without qualifiers, it usually refers to the limbs, but it also can be used to describe the muscles of the eyes , the stomach , and also the vocal cords...

 include hoarseness; vocal fatigue; mild to severe reduction in vocal volume; pain in the throat when speaking; shortness of breath; aspiration
Pulmonary aspiration
Pulmonary aspiration is the entry of material from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract...

 (food or liquids going down the trachea) with frequent resultant coughing, and in extreme cases may cause death. Gargling fluids may also become difficult. Vocal cord paresis can greatly impact daily life, employment
Employment
Employment is a contract between two parties, one being the employer and the other being the employee. An employee may be defined as:- Employee :...

, job choice, social interactions, and leisure time pursuits.

Reduced vocal cord mobility may decrease the effectiveness of coughing, swallowing, or sneezing in removing mucosal wastes from the laryngeal area. The resultant accumulations may allow for viral and bacterial colonization with an increased tendency for infections and throat discomfort.

Some causes of paresis include viral infection; cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

 or tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...

 compressing the recurrent laryngeal nerve; intramuscular tumor limiting vocal fold movement; trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

; compression of the vocal cord nerve from intubation
Intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...

, or laryngopharyngeal reflux
Laryngopharyngeal reflux
Laryngopharyngeal reflux , also extraesophageal reflux disease refers to retrograde flow of gastric contents to the upper aero-digestive tract, which causes a variety of symptoms, such as cough, hoarseness, and asthma, among others.Although heartburn is a primary symptom among people with...

. Cardiac surgery represents a risk to normal voice function as the nerves serving the larynx are routed near the heart. Damage to this nerve during open heart surgery is not uncommon. The recurrent laryngeal nerve also runs in close proximity to the thyroid gland making hoarseness of voice due to partial paralysis an important side effect of thyroid surgery. Neurological diseases such as Parkinson's can deteriorate vocal functions. Paresis may occur from an unknown cause (idiopathic).

Vocal paresis is diagnosed by observing the lack of (or reduced) motion of one or both cords using a laryngoscope. EMG (electromyography) may be used to measure the strength of the neuromuscular signal from the brain to the muscles controlling the vocal folds. This diagnosis can be made by a laryngologist or otolaryngologist with the assistance of a neurologist. In situations involving inflammation, recovery of normal motion of the vocal cords may return spontaneously.

Emotional and stress factors


The onset of vocal dysfunction may not relate to a voice overuse event or an obvious medical complication. Recent emotional events may be implicated in diminishing voice strength and control. Allowing the passage of time along with reduced demands on the voice are appropriate approaches to voice restoration. Referrals for psychological support are common, but it is important to note that numerous psychoactive medications present voice-weakening side effects. Attempting prescription medication treatment for voice weakness may mask exacerbating medical deterioration.

Surgical intervention


In the event of significant voice weakness, surgery may be required to provide temporary or permanent medialization of the vocal cords. These procedures will mechanically move the vocal cord and underlying muscular tissue toward midline (medialize) to allow a stronger "strike" against the opposite vocal cord, thus providing for a stronger and louder voice. The injection of purified animal fat is a temporary means to accomplish medialization. The surgical insertion of "buttons" of sculpted silicone or similar deformable plastic substances just inside the trachea wall will permanently medialize a vocal cord. This procedure is done under local anesthetic, to allow the patient to phonate, thus allowing the surgeon to experiment with the best size and shape of the "button" for maximal remediation. This procedure can be done unilaterally or bilaterally. In all cases, after this surgery, the relaxed position of the vocal cords will allow the passage of less breath than before the medialization. The airway is rendered smaller and this effect must be a significant consideration of the surgeon.

External links