Bilateral Vocal Cord Paralysis

Excerpt

Vocal cord paralysis refers to the immobility of the vocal cord, while vocal cord paresis refers to the impaired mobility of the vocal cord. Both can be due to processes intrinsically affecting the vocal cord itself (scarring, tumor, etc.), due to cranial neuropathies of the nerves providing vocal cord mobility [the vagus nerve, the recurrent laryngeal nerve (RLN), and the superior laryngeal nerve (SLN)], central neurologic problems [stroke, tumor, multiple sclerosis (MS), etc.], or systemic disease [amyotrophic lateral sclerosis (ALS), Guillain-Barre syndrome, etc.]. Vocal cord paralysis is most commonly unilateral, and this is discussed in detail in another StatPearls article. Here we will concentrate on the rarer bilateral vocal cord paralysis.

The vocal cords serve two functions: production of voice (phonation) and protection of the lower airways via glottic competence. The presentation and symptoms will depend upon the underlying etiology of the bilateral paralysis and the resultant position of the vocal cords. If the cords are paralyzed in a more median position, stridor and breathing symptoms may predominate (or the patient may be asymptomatic) while the voice may be normal, and no aspiration events will occur. If the vocal cords are paralyzed in a more lateral position, the airway will be widely patent and unable to close. This may present with significant voice complaints of breathiness and potential aspiration or choking, but with far fewer breathing or stridor complaints. Management will similarly depend on the underlying etiology and vocal cord position, as well as the overall prognosis of the patient.