What is vocal cord paralysis and weakness of movement in the vocal cord?
It is a condition of weakness of movement (paresis) or complete immobility (paralysis) that can be seen in one or both of the two vocal cords located in our larynx. The patient may have different complaints depending on which vocal cords are affected by the weakness of movement or paralysis or the position of the paralyzed vocal cord in the larynx.
What complaints are seen in the patient?
- Hoarseness, fatigue in the voice, breathy voice
- Aspiration into the windpipe during eating and afterwards cough.
- Shortness of breath, especially in bilateral vocal cord paralysis.
- Sore throat due to the effort of making voice during speech, pain in the neck muscles.
What causes weakness or paralysis in vocal cord movements?
Damage to the nerves that run the vocal cords is one of the common causes. Especially after gouatr (thyroid) surgeries, we frequently see unilateral or bilateral vocal cord paralysis. Apart from these operations, vocal cord paralysis may develop after neck hernia surgery, esophagus surgeries and some heart surgeries. Other causes of vocal cord paralysis: Recent upper respiratory tract infections; some tumors invading the nerves that run the vocal cord or the tumors compressing the nerve; Intubation tube compressing the nerve in those who will be operated under general anesthesia for any reason; some neurological diseases. In addition, there is a group whose cause cannot be found despite all the examinations.
How to know if there is vocal cord weakness / paralysis?
The presence of vocal cord weakness or paralysis can be revealed with an endoscopic laryngeal examination to be performed by an ENT physician after careful questioning of the patient’s history. Vocal measurements and an Electromyography (EMG) to be made on the vocal cord muscles can be added to the examination. Information can be obtained about how the recovery process of nerve functions will become with EMG. Considering the possible causes of vocal cord paralysis, neck and lung computed tomography examination and / or magnetic resonance imaging (MRI) of the brain can be performed on the patient.
What are the treatment methods used in vocal cord weakness / paralysis?
Treatment methods in vocal cord paralysis may vary according to the cause of paralysis development, whether the paralysis is unilateral or bilateral, and examination findings. General treatment methods; It is in the form of monitoring the patient, voice therapy, injecting the vocal cord, placing an implant in the vocal cord, opening the gap between the vocal cords with or without a LASER (in cases of bilateral vocal cord paralysis).
How should the treatment approach become in unilateral vocal cord paralysis and how is injection therapy (injection laryngoplasty or Intracordal injection) be performed?
In unilateral vocal cord paralysis, it is generally recommended to wait 6-12 months after the development of paralysis and to take voice therapy, if possible, during this period. In cases where there is no improvement, surgical procedures can be started, taking into account the patient’s voice needs or profession. In unilateral vocal cord paralysis, injection (filling) method is frequently applied to increase the volume of the immobile vocal cord and to strengthen the voice by providing better closing of the opposite working vocal cord during speech. In the injection method, hyaluronic acid, calcium hydroxyapatite, collagen or fat tissue (Fat tissue is taken from the person’s own body) can be applied to the vocal cords. These substances are mostly temporary substances and remain in the body for an average of 6 months to 2 years. Since the injection into the vocal cords is quite easy, it will also be easy to apply repetitions. The procedure can be performed practically through the mouth or neck under general anesthesia or local anesthesia. It is a painless procedure and even if it is performed with general anesthesia, the patient can be discharged on the same day. If the opening between the vocal cords cannot be closed with filling or if it is preferred by the patient, the implant (silicone block or gore-tex is used for this purpose), also known as thyroplasty surgery, can be placed under local anesthesia. With implant placement, a more permanent voice reinforcement is provided.
How should the treatment approach become in bilateral vocal cord paralysis?
The most important problem in bilateral vocal cord paralysis is inspiratory dyspnea (shortness of breath) due to narrowing of the airway . Especially after thyroid surgeries, we see bilateral vocal cord paralysis more frequently and patients often wake up with shortness of breath in the early postoperative period. Many times, we have to perform a hole temporarily in the patient’s throat (tracheotomy procedure) because they cannot tolerate this new condition (shortness of breath) after surgery.
In the presence of bilateral vocal cord paralysis, different approaches can be used to the patient:
1-If the patient’s shortness of breath is not very advanced despite the bilateral vocal cord paralysis and the patient can tolerate the condition, the patient can be followed closely without doing anything.
2-If we have had to perform a tracheotomy (opening a hole in the throat) to the patient, it can be followed with this tracheotomy until more permanent breath-opening procedures (such as arytenoidectomy or arytenoidopexy) are applied. This period can take up to 1 year.
3- The patient is followed up for about 1 year for a “permanent and irreversible” surgical procedure due to the possibility of the return of vocal cord functions, and if the vocal cord does not work and shortness of breath continues, procedures to open the breath passage are performed (Arytenoidectomy and / or posterior cordectomy procedures performed with LASER or without using LASER under general anesthesia)
4- Another procedure that opens the breathing passage is the process of pulling out a vocal cord with surgical sutures, called “arytenoidopexy”. In this way, the respiratory passage is enlarged and shortness of breath is reduced. There is no obligation to wait for a period of 1 year to do this procedure, and it can be used as an alternative to the method of opening a hole in the throat (tracheotomy) at the early stages of the development of vocal cord paralysis. The procedure should be done under general anesthesia. In this way, there is a chance of getting rid of the troublesome and cosmetically bad results of tracheotomy.
