Vocal cord paralysis

• Noticeable vocal fatigue
• Loss of projection
• Difficulty talking with background noise
• Limited pitch
• Lack of vocal endurance
• Micro-aspiration (minor intake of saliva and fluids) during the day

Bilateral vocal cord paralysis is rare and can put the individual at risk of suffocation. This is because the vocal cords, which are close together, can block airflow into the trachea and lungs.

• Changes in the voice (hoarseness or a breathy voice)
• Difficulty Breathing
• Swallowing problems
• Changes in voice quality

• Medialization thyroplasty is a surgical treatment for people with permanent unilateral vocal cord paralysis. During this procedure, the paralyzed vocal cord is medialized, or moved toward the midline of the body, using a permanent implant that is positioned to achieve the desired vocal quality and function. Implants can be made from safe, synthetic materials such as gore-tex, silastic or calcium hydroxide.
• Medialization thyroplasty with autograft is an advanced approach that was pioneered by Penn Medicine for people with permanent unilateral vocal cord paralysis. This procedure uses the patient’s tissue (autograft), often from the thigh rather than a synthetic material. In addition to achieving the desired vocal quality and function, this approach reduces the risk of implant rejection or wound breakdown. Patients often return home the day after surgery.
• Augmentation is the first line of treatment for people with temporary unilateral paralysis. An FDA-approved synthetic material is injected into the paralyzed vocal cord. This holds the vocal cord in the desired position to provide optimal function and reduce the risk of aspiration pneumonia while it heals. This is a temporary remedy, however, and the injectable needs to be reabsorbed within three to six months.
• In instances where temporary unilateral paralysis is a result of tumor resection during cancer treatment, augmentation is performed soon after surgery and allows for a quicker return to normal life for close to 85% of people with voice complaints.
• Augmentation at the Penn Center for Voice, Speech and Swallowing is often accompanied by speech therapy to improve breathing techniques and optimize quality of life while you heal.

• Partial endoscopic cordectomy is a minimally invasive procedure for patients with bilateral vocal cord paralysis who require tracheostomy. A tracheostomy is a procedure in which an incision is placed in the trachea to provide an alternative airway. During partial endoscopic cordectomy, a small portion of the posterior vocal cord is cut away to create an opening sufficient to result in a functional voice, yet not so large that it results in increased aspiration risk. This is a highly precise approach that is associated with significant improvement in breathing.
• Occasionally patients with bilateral vocal cord paralysis require a more advanced open surgical technique such as medialization thyroplasty or augmentation.