Vocal Cord Paralysis

Vocal Cord Paralysis

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Vocal cord paralysis can affect your voice, swallowing, and even breathing. At Duke Voice Care, our team of voice specialists will use the latest technology to diagnose your vocal cord paralysis. We will recommend the most appropriate combination of therapy and surgery to help you improve your breathing, swallowing, and speaking as quickly as possible. Appointments are available in Durham and Raleigh.

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About Vocal Cord Paralysis

Vocal cord paralysis can occur when the nerve responsible for your vocal cord movement is damaged, preventing one or both of your vocal cords from opening and closing properly. This can be due to trauma, surgical injury, stroke, a virus, or voice box tumors. Depending on the extent of the paralysis, you may have a breathy, weak, soft voice, as well as changes in swallowing and breathing. In rare cases where both vocal cords are paralyzed, it causes difficulty breathing; this requires immediate medical attention.

In some cases, voice quality can be improved with voice therapy alone. There is no surgical procedure to reverse vocal cord paralysis, but for some people the injury recovers naturally. There are also surgical procedures that "plump up" the paralyzed vocal cord to create a stronger voice and better swallowing. Whenever possible, we use less-invasive techniques, such as in-office injections to bulk up a paralyzed vocal cord.

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Voice Therapy

In some cases of vocal cord paralysis, voice therapy can help strengthen the voice. When you have vocal cord paralysis, it is important to learn how to use your entire vocal instrument. That means using breath and relaxing your throat to get your best sound. Our specially trained speech pathologists will tailor your therapy to your specific voice problems.

Temporary Vocal Cord Augmentation

Injectable fillers add bulk to vocal cords that have lost muscle tone due to aging or vocal cord paralysis. The material is injected using a tiny needle inserted into one or both vocal cords. The injection helps the vocal cords close better, creating a stronger voice. This can be done in the operating room or during an office visit. The fillers are reabsorbed by your body over time.

Permanent Vocal Cord Augmentation

Helps the vocal cords close better and improves the chronically weak, hoarse, breathy voice caused by vocal cord paralysis. A small amount of fat is removed from your belly and injected via a tiny needle to permanently plump specific areas of the vocal cords. This procedure is performed under general anesthesia. A repeat injection is sometimes needed, since some fat is reabsorbed by the body.


An implant (like a tiny shim) is placed through the voice box to reposition the paralyzed vocal cord and produce a stronger voice. This procedure requires a small incision in the neck. Thyroplasty may be recommended if your vocal cord paralysis appears permanent and your voice is weak and breathy.

Arytenoid Adduction

Surgically corrects the position of the vocal cord for better vocal cord closure and stronger voice. Sometimes used in combination with thyroplasty.

Laryngeal Nerve Re-innervation

Surgically reconnects a nerve to the weakened vocal cord muscle. This restores the vocal cord's tone and bulk, which makes the voice stronger. Full results can take two to six months.

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We will perform a comprehensive evaluation to assess your voice use patterns -- how much you speak, sing, or use a loud voice, and what your voice sounds like. With vocal cord paralysis, your team is listening in particular for a weak, breathy voice, difficulty being loud, and getting tired with speaking. Your laryngologist will evaluate the role of any medical conditions that can cause voice changes, such as surgeries or recent illness. We will perform a head and neck examination and a visual examination of your voice box. Your team will also ask about difficulties swallowing. Further testing may be recommended.


This detailed visual exam helps us evaluate how your vocal cords vibrate while you make sounds. A tiny camera attached to a small tube called an endoscope is inserted through your nose and allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow-motion video images of your vocal cords. The exam takes only about a minute, and your nose may be sprayed with topical anesthetic for your comfort.

The exam allows us to look for any lesions, stiffness, paralysis, irregular movements, throat strain, or incomplete closure of the vocal cords. Videostroboscopy is often essential to reach an accurate diagnosis and determine the best treatment approach for you.

Computerized Acoustic Analysis

If voice therapy is recommended for you, this exam is completed at your second clinic visit. A visual display is created on a computer screen as you speak into a microphone. It allows you and your speech pathologist to see characteristics of your voice, including pitch, loudness, and vocal quality. It is used to identify abnormalities, including subtle vocal problems that cannot be detected with the unaided ear. It may be repeated during treatment to monitor your progress.

Laryngeal Electromyography (EMG)

May be used to evaluate your larynx nerves and muscles by analyzing their electrical activity. As you lie on your back, small, thin electrode needles are placed in the neck muscles that move your vocal cords. You may be asked to make sounds to activate each muscle being tested. Information about nerve damage can clarify whether a vocal cord paralysis may recover and provides information about voice changes from neurological conditions such as amyotrophic lateral sclerosis (ALS).

Fiberoptic Endoscopic Evaluation of Swallowing

A flexible endoscope (a small tube with a camera and light) is passed through your nose to view your throat while you swallow brightly colored foods and liquids. You may be asked to try different swallowing positions, such as tilting your head or tucking your chin, to see which work best.

Videofluoroscopic Swallow Study

This exam makes an X-ray movie of your mouth, throat, and upper esophagus as you swallow foods and drinks of different textures and consistencies mixed with barium (a liquid visible on X-rays). It evaluates your swallowing process, whether food or liquid is entering your airway (aspiration), which types of food are easiest for you to swallow, and which positions make it easier for you to eat safely.

Barium Swallow

A barium liquid is swallowed and travels the length of your esophagus. X-ray images are taken while the liquid passes through your esophagus to show problems such as narrowing, and other concerns such as how food and liquid travel through your esophagus.

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Why Choose Duke for Vocal Cord Paralysis Care

A Team of Voice Experts
You'll have access to one of the few comprehensive voice care programs in the Southeast and its team of voice experts. Your care team will include laryngologists -- ear, nose, and throat (ENT) doctors with advanced training in voice disorders -- and highly specialized speech-language pathologists. We treat all laryngeal conditions, including voice problems, upper airway breathing problems, and swallowing disorders -- all of which may be affected by vocal cord paralysis.

Highly-Trained ENT Surgeons
If surgery is needed, our ENT surgeons have the advanced training and expertise to offer a full range of surgical options for vocal cord paralysis.

Specialized Therapy
Our trained singing voice specialists provide specialized therapy to performers and singers. They are experienced performers, singers, and singing teachers who bring empathy, clinical expertise, and an insider's perspective to improving the vocal health of singers and other vocal performers.

Coordinated Care
We coordinate your care with the right specialists throughout our health system to ensure you receive the best therapies to minimize your symptoms, improve your voice and swallowing, and optimize your recovery.

Access to the Latest Research
Our ongoing research ensures you receive the best, most up-to-date care for your vocal cord paralysis.

Reviewed: 02/22/2018