Vocal Cord Immobility

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What is vocal cord immobility?

When we breathe, the vocal cords open up to allow air to pass into the windpipe. They close against each other when we talk, swallow and cough. When one vocal cord does not move properly (unilateral vocal cord immobility), 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, patients may experience trouble breathing.

There are many possible reasons why a vocal cord does not move properly, but it most often relates to a problem with the recurrent laryngeal nerve (which controls the vocal cord muscles) rather than a problem with the vocal cord itself. Injury to the nerve following surgery in the neck or chest is a common cause of vocal cord immobility. 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 — this is called laryngeal stenosis.

Vocal Cord Immobility Treatment

The goal of treatment for unilateral VCI is to re-position the impaired vocal cord closer to the middle, so that the other vocal cord can close completely against it. If the gap between the vocal cords can be closed, then voice can be made stronger and swallowing can be made safer. This procedure to move the vocal cord over toward the middle is called medialization, and there are different ways to do it. Your physician can tell you which approach is most appropriate for you, depending on the cause of the immobility and potential for recovery of nerve function.

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

Treatment options include:

Temporary injections: A filler is injected into the vocal cord to make it thicker and move its inner edge closer to the middle. Temporary fillers often last one to three months. The procedure can often be done in a clinic, and our experts are very experienced in performing these in-office injections. Rarely, the injections cannot be performed in a clinic and must be done in an operating room.

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

Permanent implants: If return of vocal cord function is not expected for the patient, a permanent medialization may be desired. During this procedure, which is performed in an operating room, an implant is placed behind the vocal cord through an incision in the neck.

Arytenoid re-positioning: Occasionally, when the front of a vocal cord is medialized with a permanent implant, the back of the vocal cord remains open, leading to persistent symptoms. Surgeries are available to close the back of the vocal cord.

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.

Johns Hopkins Laryngology

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