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Vocal Cord Immobility

What is vocal cord immobility?

The vocal cords open up when we breathe to allow air to pass into the windpipe. They close (and vibrate) when we talk, swallow and cough. When one vocal cord does not move properly (unilateral vocal cord immobility, or VCI), it can lead to a weak, breathy voice, inability to raise the volume of the voice and the sensation of running out of air while speaking. Problems with swallowing and a weak cough are common as well. When both vocal cords do not move properly (bilateral VCI), patients may experience trouble breathing.

There are many reasons why a vocal cord may not move properly, but it is most often related to a problem with the nerve (recurrent laryngeal nerve) that controls the muscles that move the vocal cord and not a problem with the vocal cord itself. Injury to the nerve following surgery in the neck or chest is a common cause of VCI. Other causes include:

  • Stroke

  • Neurologic disorders

  • Tumors in the voice box, neck, thyroid or chest that cause the vocal cord nerve to malfunction

  • Neck trauma

  • Voice box trauma after having a breathing tube in your windpipe

Occasionally, one or both vocal cords do not move properly after scar formation or a problem with the vocal cord joint. If scars form in the back of the voice box between the vocal cords, this can cause both vocal cords to not move properly.

Vocal Cord Immobility Treatment

The goal of treatment for unilateral VCI is to move the impaired vocal cord over to the middle to close the gap between the two vocal cords during talking, swallowing and coughing. This procedure to move the vocal cord over is called medialization, and there are different ways to do this.

The choice of treatment depends upon the cause of the VCI and the possibility for spontaneous vocal cord motion recovery.

The goal of treatment for bilateral VCI is often aimed at securing a safe way for a patient to breathe. This may involve the placement of a breathing tube in the neck (tracheotomy) or making a small cut in the back of the vocal cord(s) to open up the airway for breathing. If you are diagnosed with bilateral VCI, your treatment team will have extensive conversations with you about which options are available.

Treatment options include:

Temporary injections: This involves injecting a filler behind the vocal cord to medialize it, which is to move a part toward the midline of the body. The filler is designed to last one to three months. This can often be done in the clinic, and our experts have expertise in performing these in-office injections. Rarely, they cannot be performed in clinic and require a trip to the operating room.

Long-term injections: similar to temporary injections, but the injection of a filler is designed to last one year or longer.

Permanent implants: For patients who are very likely to not have return of vocal cord function, a permanent medialization may be desired. This involves placing an implant behind the vocal cord through an incision in the neck in the operating room.

Arytenoid repositioning: Occasionally the front of the vocal cord is medialized with a permanent implant, but the back of the vocal cord remains open, leading to persistent symptoms. In this situation, there are surgeries available to close the back of the vocal cords.

Vocal cord reinnervation: For younger patients who don’t want an implant in their throat, it is possible to use alternative nerves from the neck to restore function of the vocal cord muscle. The goal is not to make the vocal cord move again but to provide nerve signals to the muscle that prevent atrophy and allow the vocal cord to maintain its shape.

Reviewed by Alexander Hillel, M.D., from the Department of Otolaryngology-Head and Neck Surgery.

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