NIDCD Fact Sheet

Vocal Fold Paralysis 

u.S. department of health & human ServiceS ∙ national inStituteS of health ∙ national inStitute on deafneSS and other communication diSorderS voice, speech, language language

What is vocal fold paralysis?

Vocal fold paralysis (also known as vocal cord paralysis) 

is a voice disorder that occurs when one or both of the 

vocal folds don’t open or close properly. Single vocal 

fold paralysis is a common disorder. Paralysis of both 

vocal folds is rare and can be life threatening.

The vocal folds are two elastic bands of muscle tissue 

located in the larynx (voice box) directly above the 

trachea (windpipe) (see figure). When you breathe, 

your vocal folds remain apart and when you swallow, 

they are tightly closed. When you use your voice, 

however, air from the lungs causes your vocal folds to 

vibrate between open and closed positions. 

If you have vocal fold paralysis, the paralyzed fold 

or folds may remain open, leaving the air passages 

and lungs unprotected. You could have difficulty 

swallowing or food or liquids could accidentally enter 

the trachea and lungs, causing serious health problems.

What causes vocal fold paralysis?

Vocal fold paralysis may be caused by injury to the 

head, neck, or chest; lung or thyroid cancer; tumors 

of the skull base, neck, or chest; or viral infection 

(for example, Lyme disease). People with certain 

neurologic conditions such as multiple sclerosis or 

Parkinson’s disease, or who have sustained a stroke, 

may experience vocal fold paralysis. In many cases, 

however, the cause is unknown. 

Structures involved in speech and 

voice production

What are the symptoms?

Symptoms of vocal fold paralysis include changes 

in the voice, such as hoarseness or a breathy voice; 

difficulties with breathing, such as shortness of breath 

or noisy breathing; and swallowing problems, such 

as choking or coughing when you eat because food 

is accidentally entering the windpipe instead of the 

esophagus (the muscular tube that connects the 

throat to the stomach). Changes in voice quality, such 

as loss of volume or pitch, also may occur. Damage to 

both vocal folds, although rare, usually causes serious 

problems with breathing.
How is vocal fold paralysis diagnosed?

Vocal fold paralysis is usually diagnosed by an 

otolaryngologist—a doctor who specializes in ear, 

nose, and throat disorders. He or she will ask you 

about your symptoms and when the problems 

began in order to help determine their cause. 

The otolaryngologist will also listen to your voice 

to identify breathiness or hoarseness. Using an 

endoscope—a tube with a light at the end—your 

doctor will look directly into the throat at the vocal 

folds. Some doctors also use a procedure called 

laryngeal electromyography, which measures the 

electrical impulses of the nerves in the larynx, to better 

understand the areas of paralysis. 

How is vocal fold paralysis treated?

The most common treatments for vocal fold paralysis 

are voice therapy and surgery. Some people’s voices 

will naturally recover sometime during the first year 

after diagnosis, which is why doctors often delay 

surgery for at least a year. During this time, your doctor 

will likely refer you to a speech-language pathologist 

for voice therapy, which may involve exercises to 

strengthen the vocal folds or improve breath control 

while speaking. You might also learn how to use 

your voice differently, for example, by speaking more 

slowly or opening your mouth wider when you speak. 

Several surgical procedures are available, depending on 

whether one or both of your vocal folds are paralyzed. 

The most common procedures change the position of 

the vocal fold. These may involve inserting a structural 

implant or stitches to reposition the laryngeal cartilage 

and bring the vocal folds closer together. These 

procedures usually result in a stronger voice. Surgery is 

followed by additional voice therapy to help fine-tune 

the voice.

When both vocal folds are paralyzed, a tracheotomy 

may be required to help breathing. In a tracheotomy, 

an incision is made in the front of the neck and a 

breathing tube is inserted through an opening, called a 

stoma, into the trachea. Rather than occurring through 

the nose and mouth, breathing now happens through 

the tube. Following surgery, therapy with a speechlanguage pathologist helps you learn how to use the 

voice and how to properly care for the breathing tube.

What research is being done on vocal 

fold paralysis?

The National Institute on Deafness and Other 

Communication Disorders (NIDCD) supports research 

studies that explore the causes of vocal fold paralysis as 

well as better ways to treat the disorder. One surgical 

procedure, called medialization laryngoplasty, inserts 

a structural implant into the larynx to return voice 

quality. However, close to a quarter of the people who 

receive this treatment must return for repositioning 

surgery to fine-tune the placement of the implant. An 

NIDCD-supported researcher currently is developing a 

pre-operative planning system that uses 3-D computer 

modeling to determine the best location for, and 

configuration of, the implant. The surgery also uses 

an image-guided system that allows the surgeon to 

visualize the precise location of the vocal fold to ensure 

exact placement of the implant. Researchers hope this 

new system will reduce the need for repeated surgeries 

and lower the cost and risk of surgical complications 

from the procedure. 

The NIDCD also has been supporting a decades-long 

project to develop an electrical stimulation technology 

to help people avoid having a tracheotomy when both 

vocal folds are paralyzed. The device, which currently is 

being tested in animals and people, uses an implanted 

pacemaker to stimulate laryngeal nerves. This returns 

mobility to the vocal folds so that they can open to allow 

breathing and close to allow speaking and swallowing. 

NIDCD Fact Sheet

Vocal Fold Paralysis

voice, speechlanguage
Where can I get help?

If you notice any unexplained voice changes or 

discomfort, you should consult an otolaryngologist 

or a speech-language pathologist for evaluation and 

possible treatment.

Where can I get additional information?

The NIDCD maintains a directory of organizations 

that provide information on the normal and 

disordered processes of hearing, balance, taste, smell, 

voice, speech, and language. Please see the list of 

organizations at http://www.nidcd.nih.gov/directory.

Use the following keywords to help you search for 

organizations that can answer questions and provide 

printed or electronic information on vocal fold 

paralysis:

•	

•	

•	

Voice 

Laryngology

Speech-language pathologist 

For more information, additional addresses and phone 

numbers, or a printed list of organizations, contact: 

nidcd information clearinghouse

1 Communication Avenue 

Bethesda, MD 20892-3456 

Toll-free Voice: (800) 241-1044 

Toll-free TTY: (800) 241-1055 

E-mail: nidcdinfo@nidcd.nih.gov

more
NIDCD supports and conducts research and research training on the 

normal and disordered processes of hearing, balance, smell, taste, 

voice, speech, and language and provides health information, based 

upon scientific discovery, to the public.

voice, speech, languagehearing, balancesmell, taste

NIDCD Fact Sheet: Vocal Fold Paralysis

Publication No. 11-4306 

Updated October 2011

For more information, contact:

NIDCD Information Clearinghouse

1 Communication Avenue

Bethesda, MD 20892-3456

Toll-free Voice: (800) 241-1044

Toll-free TTY: (800) 241-1055

Fax: (301) 770-8977

E-mail: nidcdinfo@nidcd.nih.gov

Internet: http://www.nidcd.nih.gov

The NIDCD Information Clearinghouse is a service of the 

National Institute on Deafness and Other Communication 

Disorders, National Institutes of Health, U.S. Department 

of Health and Human Services.

NIH. . .Turning Discovery Into Health