Vocal Cord Paralysis: A Stroke's Impact

A stroke can indeed cause vocal cord paralysis. This is because a stroke can damage the part of the brain that sends messages to the larynx (voice box). This damage results in nerve damage that prevents the vocal cords from opening and closing properly. This can lead to a range of problems, including difficulty speaking, swallowing, or even breathing. In severe cases, vocal cord paralysis can be life-threatening and requires immediate medical attention.

Vocal cord paralysis can be caused by a stroke

The vocal cords are two bands of muscle inside the voice box (larynx) located on top of the windpipe (trachea). They open when we breathe so air can pass through, and they close when we swallow to prevent food and drink from entering our windpipe. When we speak or sing, our vocal cords touch, and our lungs send air through them, causing them to vibrate and make sounds.

Vocal cord paralysis occurs when there is nerve damage that prevents the muscles inside the vocal cords from opening and closing properly. This can lead to trouble speaking, swallowing, or even breathing—all functions that depend on the vocal cords moving properly.

A stroke can damage the part of the brain that sends messages to the larynx (voice box), resulting in vocal cord paralysis. This happens when there is an interruption in the nerve impulses in the larynx, causing paralysis of the vocal cord muscles. While strokes outside of the cerebellum are a known cause of unilateral vocal cord paralysis, cerebellar strokes are a rare cause and rarely lead to bilateral cord paralysis. However, it is important to consider the possibility of a stroke when diagnosing vocal cord paralysis, especially if there are risk factors such as hypertension, hyperlipidemia, smoking, or other vascular risk factors.

The treatment for vocal cord paralysis depends on the severity of the condition and the patient's symptoms. Mild cases may only require voice therapy, which involves special exercises to strengthen the vocal cords and improve breath control while speaking. More severe cases may require surgery, such as bulk injection, phonosurgery, or a tracheotomy, to improve the patient's ability to breathe, speak, or swallow.

It can lead to trouble swallowing and breathing

A stroke can indeed cause vocal cord paralysis, which can lead to serious trouble swallowing and breathing.

Vocal cord paralysis occurs when the muscles that control one or both of the vocal cords cannot be moved. The vocal cords are two bands of muscle inside the voice box (larynx) that sit atop the windpipe (trachea). When we breathe, the vocal cords open to allow air to pass through, and when we swallow, they close to prevent food, drink, and saliva from entering the windpipe. When speaking or singing, the vocal cords touch and vibrate, creating sound.

With vocal cord paralysis, nerve damage prevents the vocal cords from opening and closing properly. This can lead to severe issues with breathing and swallowing, as food, fluids, and saliva can enter the windpipe and lungs, causing aspiration pneumonia, a potentially fatal condition.

Unilateral vocal cord paralysis occurs when only one vocal cord is paralysed, and while breathing problems are rare, more serious cases can cause trouble swallowing. Bilateral vocal cord paralysis, where both vocal cords are paralysed, can cause a dangerously narrow airway, leading to severe breathing difficulties that may be life-threatening without treatment.

In addition to breathing and swallowing difficulties, vocal cord paralysis can cause a range of other symptoms, including hoarseness, vocal fatigue, reduced speech volume, throat pain when speaking, and choking when swallowing. Treatment options include voice therapy and surgery, depending on the severity of the condition.

Voice therapy can help strengthen vocal cords

Vocal cord paralysis can be caused by a stroke, which may damage the part of the brain that sends messages to the larynx (voice box). This can result in nerve damage that prevents the vocal cords from opening and closing properly.

Voice therapy is a treatment option for vocal cord paralysis, and it can help strengthen vocal cords. Voice therapy is similar to physical therapy for large muscle paralysis. It involves a therapist guiding patients through exercises and activities to strengthen their vocal cords, improve breath control, and promote healthy vocal behaviours. These exercises may include breathing exercises, tension release exercises, and vocal building exercises. Voice therapy can also help prevent harmful vocal behaviours and promote healing after vocal cord surgery.

During voice therapy, patients learn techniques to improve vocal function. These techniques may include:

• Breathing exercises to help control the diaphragm, which is essential for speaking and singing.
• Tension release exercises, such as stretching and massage, to decrease throat tension.
• Semi-occluded vocal tract sounds, like straw phonation, lip trills, and humming, to promote healthy vocal cord vibration.
• Vocal building exercises to strengthen vocal cords and improve breath support for those with weak vocal cords.

Voice therapy can be an effective treatment for vocal cord paralysis, helping to improve vocal cord function and strengthen the voice. It may be recommended as a first-line treatment option before considering surgical interventions.

Surgery may be required in severe cases

A stroke can indeed cause vocal cord paralysis, which can have a significant impact on a person's daily life, including their employment, social interactions, and leisure activities. This condition is caused by nerve damage that interrupts nerve impulses in the larynx, resulting in paralysis of the vocal cord muscles.

In terms of treatment, the severity of the paralysis and the patient's symptoms determine the course of action. Voice therapy is often the first step, where patients perform special exercises to strengthen their vocal cords, improve breath control, and prevent unusual tensions in other muscles near the affected vocal cords.

However, in more severe cases, surgery may be required. Surgery is typically considered if the patient does not recover completely with voice therapy alone. There are several surgical options available:

• Bulk injection: A filler material, such as fat, collagen, or another type of safe filler, is injected into the vocal cord to bring it nearer to the middle of the larynx. This makes it easier for the opposite cord muscle to function effectively during coughing, swallowing, or speaking.
• Phonosurgery (vocal cord repositioning): This procedure involves repositioning or reshaping the vocal fold to improve voice functions.
• Tracheotomy: If both vocal folds are affected and very close together, a tracheotomy may be necessary to improve breathing. An incision is made in front of the neck, and a breathing tube is inserted to bypass the paralyzed vocal cords.
• Laryngeal framework surgery: An implant, typically made of silicone, is placed into the voice box to hold the paralyzed vocal cord in place and help both vocal cords close.
• Nerve surgery: This procedure involves reattaching a nerve from the neck to the nerve that moves the vocal cords, allowing them to function properly again.

The condition can affect one or both vocal cords

Unilateral vocal cord paralysis is much more common than bilateral vocal cord paralysis. It is rare for both vocal cords to be paralysed. However, both conditions can affect anyone of any age.

The effects of unilateral vocal cord paralysis range from mild to severe. In mild cases, the main symptom may be a weak or breathy voice. In more severe cases, the patient may experience shortness of breath when speaking, or coughing and choking when eating or drinking.

When both vocal cords are paralysed, they are usually very close together, resulting in a dangerously narrow airway. This can cause serious breathing difficulties which may be life-threatening without treatment. Food or drink may slip into the windpipe and lungs, causing aspiration pneumonia.

The treatment for vocal cord paralysis depends on the severity of the condition. Voice therapy can help strengthen the vocal cords and improve breathing while speaking. In more severe cases, surgery may be required.

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