Bilateral Vocal Cord Paralysis

 

Bilateral vocal cord paralysis can be either neurologic or stenotic in origin.  A neurologic cord paralysis refers to both nerves to the right and left vocal cord being dysfunctional, which can occur as a congenital malformation, as a toxic side effect to medication such as chemotherapy, or secondary to a surgical procedure (most commonly thyroidectomy).

 

A stenotic vocal cord paralysis implies that scar tissue has formed at the vocal cords which lock the vocal cords in place, preventing them from opening for proper inhalation.  This is often secondary to prolonged intubation in an ICU where an overly large intubation tube lies between the vocal cords and causes a pressure ulcer, which eventually forms a scar.

 

Treatment can be challenging as there is no perfect solution.  A laser cordotomy (removing a portion of the scarred vocal cord) can open up the airway to improve breathing but it necessarily creates a more breathy voice.  A tracheostomy can provide a good airway and maintain a satisfactory voice, but it comes with the inconvenience of maintaining a tracheostomy.  Each individual patient must choose what is right for them.