Vocal Fold Paralysis

[en Español]

When your vocal folds do not move the way they should, your voice will change. Speech-language pathologists, or SLPs, can help.

On this page:

About Vocal Fold Paralysis

Your vocal folds are inside your larynx, or voice box. When you talk, air moves from your lungs through the vocal folds to your mouth. The vocal folds vibrate to produce sound. Anything that makes it harder for the vocal folds to vibrate can cause a voice problem. Vocal fold paralysis happens when one or both vocal folds are not able to move. It can also cause breathing and swallowing problems.

There are different types of vocal fold paralysis. Bilateral vocal fold paralysis means that both vocal folds will not move. They become stuck halfway between open and closed. People with this condition often need a tracheotomy, which is an opening made in the neck. They breathe through this opening, and it keeps food from going into their lungs when they eat.

Unilateral vocal fold paralysis is when only one fold will not move or only moves a little bit. It is more common than bilateral paralysis. The paralyzed vocal fold does not vibrate with the other fold. The person’s voice will not sound clear or loud. They may run out of air when speaking.

Signs of Vocal Fold Paralysis

Vocal fold paralysis can cause problems that are mild or severe. Some signs include:

  • Hoarseness
  • Breathy voice
  • Being unable to speak loudly
  • Limited pitch and loudness
  • Being able to produce voice for a very short time
  • Choking or coughing while eating
  • Possible pneumonia if food and liquid get into the lungs. This may happen if the vocal folds cannot close to protect the airway while swallowing.

Causes of Vocal Fold Paralysis

Nerve damage causes vocal fold paralysis. The vagus nerve runs from the brainstem to the larynx. This nerve controls vocal fold movement. Anything that damages this nerve can cause paralysis. This includes head and neck injuries, tumors, disease, surgery, or stroke.

Testing for Vocal Fold Paralysis

You should see your doctor if you have trouble with your voice. You may want to see an otolaryngologist, or ear, nose, and throat doctor, who knows about voice problems. A speech-language pathologist, or SLP, can test how your voice sounds. The SLP or doctor can look at your vocal folds through a tube that goes into your mouth or nose, called an endoscope. A flashing light, called a stroboscope, lets the team watch your vocal folds move.

Treatment for Vocal Fold Paralysis

Bilateral paralysis requires medical treatment. You may need to have a tracheotomy so you can eat safely. You might have surgery to bring one or both vocal folds closer to the middle.

You may need medical treatment for unilateral paralysis. This might include muscle-nerve transplant or surgery to move the paralyzed fold toward the middle. You might also have something injected into the fold to make it larger. This allows the other fold to move closer to it and may help your voice.

Voice therapy can also help unilateral paralysis. You can work with an SLP on changing your pitch and getting more breath support to speak louder. Changing your head position or pushing on your larynx may help your voice. Your doctor may want you to try voice therapy before you look into surgery or other medical treatments. It may be the only treatment that you need.

See ASHA information for professionals on the Practice Portal's Voice Disorders page.

To find a speech-language pathologist near you, visit ProFind.

Other Resources

This list does not include every website on this topic. ASHA does not endorse the information on these sites.