Vocal Cord Paralysis

Vocal cord paralysis is a common clinical condition in otolaryngology practice and can affect not only the quality of life of the patient but at times can be life threatening. After discussing the pathophysiology of this condition, we intend to elaborate on the two common types of vocal cord paralysis that is encountered, the unilateral and bilateral vocal cord paralyses. Unilateral vocal cord paralysis is seen associated with iatrogenic surgical trauma in the form of thyroid surgery where one cord is found in the adducted position leading to hoarseness of voice which can be assessed clinically by flexible or rigid laryngoscopy. The various treatment options include observation, speech therapy, and surgery. Bilateral vocal cord paralysis has more sinister clinical implications and is usually seen after thyroid surgery. Intubation trauma with arytenoid injury should also be kept in mind as a possible etiology. If after observation for 5-10 days, the cords are still immobile, tracheostomy may have to be considered. Other reversible procedures are also mentioned. Permanent surgical management still remains laser cordotomy though newer techniques like laryngeal pacemakers are being tried out in various centers.