Vocal Cord Paralysis: Where Did My Voice Go?

Temporarily losing your ability to speak can be frustrating. But what if you lose it for weeks, months or even years?

This is the challenge facing individuals who suffer from vocal cord paralysis, a condition that causes loss of control of the muscles that give you your voice. Your vocal cords – also known as vocal folds – also play a role in breathing and swallowing.

The condition drew attention recently when actress Kimberly Williams-Paisley revealed a two-year battle to regain her voice. The actress suddenly lost the ability to speak above a whisper in late 2022, and only regained it through surgery to treat partial paralysis of her left vocal cord.

Vocal Cord Paralysis Symptoms

Vocal cord paralysis can affect one or both of the vocal cords. Unilateral paralysis affects a single vocal cord, making it difficult to speak and, in some cases, swallow. Bilateral paralysis affects both vocal cords, often resulting in difficulty breathing.

Symptoms can vary from person to person, but they often include:

• Change in voice including hoarseness, scratchiness or breathy character
• Pitch change in your voice
• Noisy breathing that may be raspy or wheezy
• Inability to project your voice loudly
• Shortness of breath while talking
• Coughing or choking while swallowing food or drinks
• Difficulty clearing throat by coughing

It’s also common for symptoms to vary throughout the day. You may feel like your voice is strong in the morning but becomes weak as the day goes on.

What Causes Vocal Cord Paralysis?

Vocal cord paralysis usually occurs when there is pressure or damage to the nerve – recurrent laryngeal nerve – that carries signals to your voice box. This nerve takes a long course, traveling down into the chest before looping back up to your larynx. This long pathway makes it vulnerable to damage from a variety of sources. These include:

• Surgery: The nerve can be injured during surgeries around the neck or heart. This is particularly common with procedures involving the thyroid gland, which sits very close to the recurrent laryngeal nerves. Even the slightest tension on the nerve or procedural swelling can cause temporary or permanent injury.
• Tumors: Cancerous and noncancerous tumors can put pressure along that nerve pathway.
• Neurological conditions: Parkinson’s disease, multiple sclerosis and other conditions can be a factor.
• Stroke: When blood flow to the brain is interrupted, it could damage the area of the brain that communicates with the voice box.
• Chest or neck injuries: Trauma can damage the recurrent laryngeal nerve.
• Postviral vagal neuropathy: This condition can occur after a cold or upper respiratory infection damages the vagus nerve. In these instances, even after you get over the cold, your voice doesn’t recover.

What You Can Do

Before treatment begins, your care team will evaluate your condition to determine its cause and severity. In many cases, the initial recommendation may be voice therapy. You will learn exercises and activities that can strengthen the sound of your voice and minimize tension in the muscles around them.

If therapy alone isn’t enough, your doctor may suggest procedures to improve position of the paralyzed vocal cord. Often, injections are performed to add bulk to the weakened vocal cord using a filler (body fat, collagen or other substance).

In some cases, surgery may be the best option for voice restoration. Surgery generally involves repositioning the paralyzed vocal cord in a more favorable position. This allows the functioning vocal cord to more easily contact the paralyzed one leading to improved voice production.

As with many medical conditions, the sooner you seek treatment, the better your prospects are for recovery. Respiratory illness like colds can lead to voice change that will resolve on its own. Therefore, giving yourself a few weeks to rest and recover is reasonable.

If symptoms last beyond that, or you experience sudden voice loss without an obvious explanation, a visit with a speech language pathologist or laryngologist is warranted.