Vocal Cord Paralysis

A 67-year-old man had been hoarse since undergoing a thyroidectomy for carcinoma nearly 3 months ago. Indirect laryngoscopy now confirmed paralysis of the right vocal cord, which was fixed in the paramedian position. The left vocal cord appeared normal.

This paralysis was caused by damage to the recurrent laryngeal nerve, which furnishes the primary motor innervation to the intrinsic laryngeal musculature. In 90% of cases, vocal cord paralysis is caused by a peripheral nerve injury; the remaining 10% are due to pathologic conditions of the CNS (eg, multiple sclerosis or peripheral vagal neuropathy). The involvement may be unilateral or bilateral. Bilateral vocal cord paralysis may be associated with respiratory distress, since both vocal cords are close to the midline.

Write Drs Sonia Arunabh and Navin Verma of Flushing, NY, vocal cord paralysis may result from endoscopy as well as neck or chest surgery. Thus, when a patient complains of hoarseness, it is mandatory to obtain a history of external and internal trauma to make the correct diagnosis. Thyroidectomy is the most frequent cause of both unilateral and bilateral paralysis.

Treatment is generally not necessary for unilateral paralysis, because compensation occurs over time. Consider vocal cord injection therapy, however, if excessive hoarseness, ineffective coughing, or aspiration persists. The patient described here refused further care.