Vocal Cord Paralysis: Diagnostic Approaches and Imaging

Introduction

Vocal cord paralysis is a condition that affects the movement of the vocal cords, leading to voice disturbances, breathing difficulties, and aspiration risks. Accurate diagnosis is essential to determine the underlying cause and provide appropriate treatment.

Causes of Vocal Cord Paralysis

• Neurological disorders such as stroke and multiple sclerosis
• Surgical trauma, especially following thyroid, cardiac, or neck surgery
• Viral infections affecting the recurrent laryngeal nerve
• Neoplastic compression from tumors

Diagnostic Approaches

Clinical Evaluation

Patients typically present with dysphonia, breathiness, weak voice, or stridor. A thorough history and physical examination help identify potential etiologies.

Laryngoscopy

Flexible or rigid laryngoscopy is a gold-standard diagnostic tool for assessing vocal cord mobility. It helps visualize unilateral or bilateral paralysis and associated abnormalities.

Electromyography (EMG)

Laryngeal EMG assesses neuromuscular function and distinguishes between paralysis and mechanical fixation.

Imaging Modalities

CT and MRI

CT scans of the neck and chest help evaluate potential mass effects, tumors, or vascular compression. MRI provides detailed soft tissue imaging for neurological causes.

Ultrasonography

High-resolution ultrasound aids in assessing thyroid pathology and recurrent laryngeal nerve injury.

Management Strategies

• Speech therapy for voice rehabilitation
• Surgical interventions such as medialization laryngoplasty
• Nerve reinnervation procedures
• Botulinum toxin injections for spastic dysphonia

Conclusion

Early diagnosis using clinical evaluation, laryngoscopy, and imaging helps guide effective management strategies for vocal cord paralysis, improving patient outcomes.