Laryngeal Palsy: Vocal Fold Paralysis Causes and Management

Laryngeal palsy (vocal fold paralysis/paresis) is impaired mobility of the true vocal folds due to vagus/recurrent laryngeal nerve dysfunction.

Etiology

• Surgical injury (thyroid, thoracic, cervical spine)
• Neoplasm (thyroid, lung, esophageal, mediastinal)
• Neurologic (stroke, MS, Guillain-Barré)
• Idiopathic (viral neuritis suspected)
• Intubation trauma

Presentation

• Unilateral: breathy voice, weak cough, aspiration risk.
• Bilateral: airway obstruction, stridor (emergency).

Management

Voice therapy, injection laryngoplasty (temporary), medialization thyroplasty (permanent), arytenoid adduction. Bilateral may need tracheostomy or posterior cordotomy.