Vocal Fold Paralysis and Paresis

VOCAL FOLD PARALYSIS AND PARESIS – SEE POWER POINT

Description. Vocal fold paralysis is a condition in which one or more nerves to the vocal folds work poorly, and the vocal fold does not move or deform normally. In most cases, the vocal folds do not close, or do not close well. Also, the vocal folds may not elongate normally to produce high pitch. In other cases, which are more rare, the vocal folds do not come apart properly, and breathing can be difficult. Paresis is a similar condition, only less severe.

Causes. Vocal fold paralysis and paresis can be cause by many different things. One of the most common causes appears to be viral: a person gets a cold or upper respiratory flu, resulting in a temporary laryngitis that then does not resolve normally. Other common causes are surgery (chest, neck, or shoulder surgery), heart problems, and more rarely, tumors or brain diseases.


Treatment.

  • Voice therapy – techniques include hard glottal attack exercises, lateral digital pressure, head tilt method, vocal function exercises, and half-swallow boom technique. These methods are utilized to reduce the vocal and laryngeal hyperfunction that results in an attempt to compensate for lack of glottic closure.
  • Phonosurgery – Two surgical options used include medialization thyroplasty and laryngeal reinnervation. Medialization thyroplasty involves surgery to push the paralyzed vocal fold closer toward the middle so that the other vocal fold does not have to work so hard for the vocal folds to come together for voicing, and may be a helpful option when aspiration is persistent. It involves implantation of a small device, made from silastic or Gore-Tex, into the vocal fold to optimize its position for better closure during speaking and singing.
  • Combination – because speech therapy, in isolation, is often ineffective.