Vocal Cord Paralysis Or Paresis

Your Path

  • Vocal cord paralysis or paresis


  • Typically from recurrent laryngeal nerve or vagus involvement, with unilateral more common than bilateral
  • Cancer of: thyroid, larynx, mediastinum, other head/neck
  • Trauma from intubation, other neck trauma
  • Surgical injury→ e.g. thyroid or parathyroid surgeries; carotid endarterectomy; cardiac or other mediastinum surgery
  • Neurological disorder (e.g. organophosphate poisoning, ALS, myasthenia)
  • Idiopathic - when no other process identified

Risk Factors

  • If related to surgery, risk goes up with repeat operation (scarring), failure to identify the nerve at time of surgery, less experienced operators, more extensive surgery
  • Malignancy of head/neck, mediastinum


  • Typically causes a breathy voice (unilateral nerve dysfunction), hoarseness, vocal fatigue
  • SOB, DOE, respiratory distress with bilateral involvement
  • Sometimes dysphagia, coughing
  • If neurological disorder (e.g. ALS), then will have additional symptoms

Physical Exam Findings

  • Soft or breathy voice
  • Respiratory distress, stridor if bilateral involvement
  • Other neurological findings if there's an underlying disorder