ear, nose, and throat disorders
Vocal Cord Paralysis
Key Points
Vocal cord paralysis can be caused by a lesion or dysfunction anywhere in the neural pathway to the larynx (the nucleus ambiguus, its supranuclear tracts, the main trunk of the vagus, the recurrent laryngeal nerves). Most paralyses are unilateral and affect mainly the voice, but bilateral paralysis can occur and obstruct the airway. Paralysis is diagnosed by laryngoscopy, but identification of the cause typically requires imaging (eg, MRI) and other tests. Patients with bilateral paralysis often require tracheal intubation/tracheotomy initially, before corrective surgical procedures are attempted. Various surgical procedures are available to improve voice quality in unilateral paralysis or to improve airway patency in long-term bilateral paralysis. 