Vocal Cord Paralysis

Zeng Quan

Department of Otolaryngology
The First Affiliated Hospital
Chongqing Medical University
 Vocal cord paralysis is a
common problem found in the
practice of Otolaryngology.

It is a sign of disease and

not a diagnosis.
Nerve Supply of Larynx
Course of left and right vagus nerves.
The Vagus Nerve
The Laryngeal nerve
Classification of laryngeal paralysis
 Unilateral or Bilateral

 Recurrent laryngeal nerve

 Superior laryngeal nerve

 Both
Etiology of Laryngeal Paralysis
Site of laryngeal paralysis

Supranuclear

Infranuclear
Intracranial causes

Acute bulbar palsy

Motor neuron disease

 Vascular lesions

Tumors
Lesions at the base of skull

Nasopharyngeal tumors

Fractures of the base of the skull

 Secondary deposits in the lymph

nodes at the base of the skull
Causes in the neck

Thyroidectomy

Thyroid carcinoma

 Trauma to the neck

 Tumors and trauma to the

esophagus and trachea in the neck
Causes in the chest

Bronchogenic carcinoma with

secondaries in the mediastinal nodes

Esophageal carcinama

 Apical tuberculosis

Aortic aneurysm
Miscellaneous causes:
Neuritis due to alcohol,diabetes,saroidosis

Idiopathic
One -third of the cases are idiopathic.
Other Causes(Unilateral)
Other Causes (Bilateral)
Unilateral
Recurrent Laryngeal Nerve Paralysis
Clinical features(Unilateral paralysis)
 Nonfunction of the intrinsic muscles
of the larynx on the affected side
cause the vocal cord to assume a
paramedian position.
 The voice is breathy but
compensation occurs, though
rarely back to normal.
 The airway is adequate and may
become compromised only with
exertion.
Diagnosis
History and head and neck examination

Laryngoscopy

Videostroboscopy

 X-ray,CT,MRI

Electromyography (EMG)
Immobility and paralysis are not necessarily synonymous.
It can help to clarify if the immobility is due to nerve injury or joint fixation.
Management – Unilateral Paralysis

Treatment of unilateral vocal fold paralysis aims at

improving voice quality and preventing aspiration.
Satisfactory history

Voice evaluation

Etiology of paralysis,

Assessment of compensation

Expected recovery.
Voice Therapy

Surgery
Bilateral
Recurrent Laryngeal Nerve Paralysis
 Clinical features(Bilateral paralysis)

 Usually result of damage

to both RLN.
 Cords lie in paramedian
position
 Voice is good
 Variable degree of stridor
Bilateral Recurrent Laryngeal Nerve
Injury
 As both the cords lie in median or paramedian
position,the airway is inadequate causing dyspnoea
and stridor but voice is good.

 Dyspnoea and stridor become worse on exertion or

during an attack of acute laryngitis.
Evaluation – Physical Examination
 Complete Head and Neck
Examination
 Flexible Fiberoptic
Laryngoscopy
 Adequacy of Airway, Gross
Aspiration
 Assess Position of Cords
 Median, Paramedian, Lateral
 Posterior Glottic Gap on
Phonation
Radiologic Evaluation
CT
CT scanning of the neck, including the skull base and thoracic inlet

MRI
If a central neurologic disorder is suspected, MRI may be more appropriate
than a CT.
Management
Bilateral Abductor Paralysis
 Patients exhibit lack of
abduction during inspiration,
but good phonation
 Maintenance of airway is
the primary goal
 Airway preservation often
Inspiration
damages an otherwise
good voice

Expiration
Management
Bilateral Abductor Paralysis
 Tracheostomy
 Gold standard
 Most adults will require this
 Speaking valves aid in phonation
 Laser Cordectomy
 Laser Arytenoidectomy
Laser Arytenoidectomy
Conclusions – Key Points
Conclusions – Key Points

 Management – Unilateral Paralysis

 Anterior and Posterior Glottic gap must be
addressed
 Arytenoid adduction is irreversible
 Continued improvement up to 6month-1year

Management – Bilateral Paralysis

 Preservation of airway is most important goal
THANK YOU!