Is your voice hoarse? This could be due to vocal cord paralysis.

Sometimes, when we wake up in the morning, our voice feels a little different, doesn't it? Or when we finish singing a good song, or when we shout and speak, our voice becomes a little hoarse. Usually, these things get better in a day or two. But if your voice has been different or hoarse for weeks, if you feel tired when you speak, or if you feel like you're choking when you swallow food and drink, it's not something to be taken lightly. Today, we're going to talk about one specific condition that can cause such symptoms. That is vocal cord paralysis, or as we say in English, a condition called 'Vocal Cord Paralysis'.

Simply put, what is vocal cord dysfunction?

To understand this, let's first look at what these vocal cords are. Imagine that inside our throat, specifically at the beginning of the trachea, in the part called the larynx, there are two thin bands of muscle. Like two doors on a gate. These are what we call the vocal cords.

There are several functions of these:

• When you breathe: These two bands move apart, making way for air to enter the lungs.
• When swallowing food: These close tightly and protect food from entering the airway.
• When we speak: Our voice is produced when these two bands come together and vibrate with the air coming from the lungs.

Now you understand how important these vocal cords are? So, vocal cord dysfunction means that there is some damage to the nerves that control these vocal cords, and these muscle bands do not work properly. That is, these 'gate doors' do not open and close properly. This can make it difficult to speak, swallow, and sometimes even breathe.

There are two main types of this condition.

This vocal cord dysfunction can be divided into two main types, depending on whether one or both vocal cords are dysfunctional.

Do you also have these symptoms?

The symptoms of vocal cord dysfunction can vary depending on how severe it is and the location of the dysfunctional vocal cords.

These are the common symptoms:

• Voice changes: hoarseness, weakness, breathy sound.
• Changes in pitch and volume: The pitch and volume of the voice may change.
• Shortness of breath when talking: It becomes difficult to breathe even after talking for a short time, and you feel tired.
• Wheezing: Wheezing may occur when breathing.
• Difficulty swallowing (Dysphagia): A feeling of a lump in the throat when swallowing food or drink.
• Choking: Feeling like you're constantly choking when you drink a little water or eat food.
• Difficulty clearing the throat: Feeling like mucus is stuck in the throat, but it is difficult to clear it.

What are the reasons for this situation?

There are many reasons why the nerves that control the vocal cords can be damaged. Sometimes, no cause can be found.

Here are some of the main reasons:

• Surgery: These nerves can be damaged, especially during surgeries involving the neck, chest, and head (for example, thyroidectomy). They can also sometimes be damaged by the breathing tube placed during anesthesia during surgery.
• Injury: A severe accident to the neck, head, or chest can damage nerves.
• Neurological diseases: Diseases that weaken the nerves, such as Parkinson's disease, multiple sclerosis (MS), or stroke, can affect these nerves.
• Tumors: Tumors, whether malignant or benign, that develop in the larynx or along the nerve pathways can compress and damage nerves.
• Infections: Some viral infections, for example, herpes, Epstein-Barr virus, and COVID-19, can cause inflammation and damage to the nerves.
• Autoimmune diseases: This condition can also be caused by diseases in which the body's own immune system attacks the nerves, for example, myasthenia gravis.
• Poisonous substances: Ingestion of toxic substances such as lead, mercury, and arsenic can damage nerve tissue. If you suspect that you have ingested a toxic substance, immediately call the National Poison Information Center at the Colombo National Hospital for advice.

Sometimes this condition can occur even after a common cold. Cases where no clear cause can be found are called 'idiopathic'.

How does a doctor find this?

If you have these symptoms, you should definitely see an ear, nose, and throat specialist (ENT surgeon). The doctor will first listen carefully to your symptoms and medical history. After that, they may do several tests to confirm the diagnosis.

• Laryngoscopy: This involves inserting a thin tube with a small camera through your nose or mouth to look directly at your vocal cords. Don't worry, you'll be given a numbing medicine if necessary before doing this. This allows you to clearly see whether your vocal cords are moving or not.
• Videostroboscopy: This is similar to laryngoscopy, but it uses a special camera to watch the vocal cords vibrate in slow motion as you speak.
• Imaging studies: A CT scan or MRI scan may be done to check for lumps in areas such as the brain, neck, and chest.
• Laryngeal electromyography (LEMG): This measures the electrical signals sent from the nerves to the muscles of the larynx. This can help determine if the nerves are damaged.
• Blood tests: Blood tests may be done if an infection or autoimmune disease is suspected.

What are the treatments for this?

Treatment is determined by the severity of the disease, symptoms, and its cause.

Voice Therapy

This is the primary treatment. It is very effective, especially if the condition is not too severe. Here, a speech-language pathologist will teach you special exercises to strengthen your vocal cords and control your breathing while speaking.

Surgery and other treatments

If the condition is severe or cannot be controlled with voice therapy, surgery may be necessary.

• When one vocal cord is inactive (Unilateral Paralysis):
• Vocal cord injection: In this procedure, a special filler is injected to fill the gap between the vocal cords. This makes it easier to speak and swallow.
• Laryngeal framework surgery: In this, an implant made of a material such as silicone is inserted into the larynx through a minor surgery, pushing the dysfunctional vocal cord into the middle. This makes it easier for the other vocal cord to come in and close.
• Reinnervation: This involves taking a healthy nerve that goes to another muscle in the neck and connecting it to the nerve in the dysfunctional vocal cords.

• When both vocal cords are inactive (Bilateral Paralysis):
• Since the main problem in this is difficulty breathing, the first thing to do is to create a breathing path. The main thing to do for that is a tracheostomy surgery.
• In this surgery, a small hole is made in the front of the neck and a tube is inserted directly into the windpipe. This allows the patient to breathe more easily.
• Additionally, laser beams can be used to remove a small section of the back of the vocal cords to widen the airway.

When should you see a doctor immediately?

If you have symptoms like a change in your voice, a hoarseness, or difficulty swallowing, don't ignore it and see a doctor. The sooner you start treatment, the better you can prevent the condition from getting worse.

Difficulty breathing can be a sign of both vocal cords failing. Also, if food or drink gets stuck and goes into the lungs, it can cause serious infections like aspiration pneumonia. So be very careful about these symptoms.