 If the paresis is persistent, surgical options such as vocal fold injections or tracheotomy can be taken into consideration.Many viral infections have been reported as a cause for VF paresis, including herpes simplex virus, Epstein-Barr virus, Varicella-Zoster, cytomegalovirus, HIV, West Nile virus, and upper respiratory infection.Bacterial infections have also been reported to cause VF paresis, such as syphilis and Lyme disease.