Recurrent Palsy - Vocal Cord Paralysis

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Recurrent Palsy - Vocal Cord Paralysis
Recurrent Palsy - Vocal Cord Paralysis

Video: Recurrent Palsy - Vocal Cord Paralysis

Video: Recurrent Palsy - Vocal Cord Paralysis
Video: Laryngeal Nerve Palsy or Paralysis (Anatomy, physiology, classification, causes, pathophysiology) 2023, September

Recurrent palsy

Recurrent palsy occurs as a result of damage or paralysis of a certain nerve (inferior laryngeal nerve, recurrent laryngeal nerve). Among other things, this is involved in the movement of the vocal folds. Vocal folds are folds in the larynx that contain the vocal cord and vocal muscle. Among other things, they are important for voice generation. Depending on the position and tension of the vocal folds, tones of different frequencies can be generated. The trachea can be closed up to a small gap through the vocal folds, so that a sound is produced. If this gap is open, air enters the windpipe (breathing). Depending on the severity of the paralysis, symptoms range from hoarseness to shortness of breath.

Paralysis can occur in different parts of the nerve for a variety of reasons. These are, for example, pathological processes such as tumor diseases or metastases in the head, neck or chest area or injuries caused by surgery.


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  • What are the causes of recurrent palsy?
  • What are the symptoms?
  • How is the diagnosis made?
  • How is the treatment carried out?
  • Whom can I ask?

What are the causes of recurrent palsy?

Possible causes are:

  • Tumor diseases in the neck, head and chest area or metastases, e.g. in lung cancer. More information on cancer.
  • Injuries during operations in the area of the nerve (e.g. thyroid surgery, heart surgery, surgery of the aorta in the thorax). Particular attention is therefore paid to these operations - including postoperatively for special symptoms.
  • Diseases that press on the nerve due to their size, e.g. thyroid disease (enlargement, goiter) or aortic aneurysm, left heart failure.
  • Injuries to the larynx.
  • Neurological disorders such as bleeding in the brain or stroke that damage areas of the brain related to the nerve.
  • Diabetic neuropathy, neuritis.
  • Infections.
  • If the cause is unclear, it is called idiopathic recurrent palsy.

What are the symptoms?

Symptoms vary depending on the cause and whether one or both vocal folds are affected. The position of the paralyzed vocal folds also plays a role.

With one-sided paralysis it comes to, among other things

Hoarseness (can also be slight)

With bilateral paralysis (double-sided paralysis) it comes to:

  • Hoarseness (less pronounced),
  • Shortness of breath (severe),
  • possibly stridor (abnormal breathing sound when inhaling).

If both vocal folds are paralyzed and completely closed, immediate action must be taken to prevent suffocation (emergency number 144). This manifests itself in very severe shortness of breath. Even if the gap between the paralyzed vocal folds is small, it leads to severe shortness of breath.

How is the diagnosis made?

Hoarseness and shortness of breath can have different causes. These are clarified with the help of anamnesis and various examinations. In addition to the symptoms, for example, illnesses and operations, such as the thyroid gland or heart / lung operations, are essential. In the course of the diagnosis, for example:

  • Laryngoscopy,
  • radiological examinations (e.g. ultrasound, CT) as well
  • EMG, to check the excitability of the vocal folds.

How is the treatment carried out?

The treatment is based on the cause, severity and symptoms. If a disease is the cause, it is treated. For example, if an aneurysm presses on the nerve, surgery can be performed. It is also important for the treatment whether one vocal fold is affected or both vocal folds are paralyzed.

In the case of unilateral recurrent palsy:

  • Speech therapy voice training.
  • If this is not successful, an endoscopic or surgical intervention may be necessary

    • Injection with hyaluronic acid or calcium hydroxylapatite and alignment of the vocal folds,
    • Relocation of the vocal folds by means of cartilage or silicone sequent implants (thyroplasty).

In the case of bilateral paralysis, the focus is on reducing shortness of breath:

  • If the ENT department is within reach, a special suture technique in the larynx can be used to relocate a vocal fold and widen the vocal fold space.
  • Otherwise, a tracheotomy (also: tracheal incision. In this case, an incision is made in the front of the neck area directly into the trachea to ensure breathing) and a cannula are necessary (acute).
  • If there is no improvement in the first nine months, further interventions can be carried out (surgical intervention to pull the vocal cords apart and fix the position or the glottis).

Whom can I ask?

If you have problems with your voice, e.g. hoarseness, but also if you have abnormal breathing noises, you can contact:

  • Family doctor (who can arrange referrals if necessary).
  • Specialist in ENT (larynx surgery, endocrine surgery).

Depending on the causes, speech therapists, neurologists, endocrinologists, etc. may also be involved.

Note If you are short of breath, dial the emergency call immediately (144) and follow the instructions of the emergency call center!