Vocal cord paralysis

Vocal cord paralysis/paresis (VCP), also known as vocal fold paralysis/paresis, refers to the impaired mobility of the true vocal cord or fold due to neurologic dysfunction.

Unilateral vocal cord paralysis usually presents with dysphonia (hoarseness), characterized as a breathy, weak voice due to air leaking through the glottic gap as one vocal cord is unable to adduct fully. Patients may also complain of dysphagia or choking as glottic incompetence increases the risk of aspiration.

Bilateral vocal cord paralysis may present as dyspnea if the paralyzed cords rest close to the midline, reducing the glottic area available for air movement.

The diagnosis may also be made incidentally on laryngoscopy or imaging as up to one-third of patients with impaired vocal cord impairment are asymptomatic 1.

Neurologic dysfunction resulting in vocal cord paralysis most common localizes to the recurrent laryngeal nerve, but can also be due to upstream lesions affecting the vagus nerve (from which the recurrent laryngeal nerve branches off) or the brain. Injury to the recurrent laryngeal nerve affects motor function of most of the intrinsic laryngeal muscles (posterior cricoarytenoid, lateral cricoarytenoid, transverse arytenoid, oblique arytenoid, and thyroarytenoid).

In comparison, injury to the superior laryngeal nerve, which supplies only the cricothyroid muscle, causes subtle changes in voice and is less clinically significant.

Unilateral involvement is much more common than bilateral involvement 7. The left side is most commonly affected, likely because the longer course of the left recurrent laryngeal nerve presents greater opportunity for injury.

The imaging features of vocal cord paralysis include:

When vocal cord paralysis has been diagnosed, a cause should be actively sought along the course of the recurrent laryngeal nerve from origin in the brainstem, through the neck, and should always include the superior mediastinum. 

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Article information

rID: 21747
System: Head & Neck
Synonyms or Alternate Spellings:
  • Vocal fold paresis
  • Vocal fold paralysis
  • Vocal cord palsy
  • Paralysis of the vocal cord
  • Vocal cord paralysis (VCP)
  • Paralysis of the vocal cords

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Cases and figures

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  • Case 2: due aortic arch pseudoaneurysm
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  • Case 4: due to papillary thyroid carcinoma
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