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

• Online vocal disorder community (VoiceMatters.net)
• list of voice effects of the top 100 prescribed medications
• Overview at CNN
  CNN
  Cable News Network is a U.S. cable news channel founded in 1980 by Ted Turner. Upon its launch, CNN was the first channel to provide 24-hour television news coverage, and the first all-news television channel in the United States...
  
  
• Overview at Merck Manual
• Overview at Mayo Clinic
  Mayo Clinic
  Mayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
  
  
• National Center for Voice and Speech
• nidcd.nih.gov
• http://pvcrp.com/links_to_related_websites.php at Links to Voice Clinics