Vocal fold paralysis is less common than the first two groups of disorders. It usually involves paralysis of one vocal fold, and results in inability to close the vocal folds completely. If the vocal folds do not close completely, the voice is weak and hoarse and there may be choking on swallowing due to food or liquids going into the windpipe.
As with other voice disorders, examination of the vocal folds with nasoendoscopy or videostroboscopy may be required.
Other investigations may include CT or MRI scanning to look for the cause of the paralysis. The specialist may also discuss transnasal oesophagoscopy to examine the food passage (this can be carried out in the clinic); and laryngeal electromyography, which uses a fine needle to measure function of the vocal fold muscle.
Sometimes recovery occurs by itself and no action is needed. Depending on the cause of paralysis this may take up to a year. While waiting for the nerve to recover, speech therapy or an injection to bulk up the paralysed vocal fold may be helpful.
Sometimes an operation (medialisation thyroplasty) is needed to permanently shift the paralysed vocal fold to improve the voice. This operation can be carried out under local anaesthetic and the specialist will discuss the options with you.
Rarely, if the paralysis involves both vocal folds, there can be difficulty breathing or noisy breathing due to narrowing of the airway. In this situation, a surgical procedure called a tracheostomy may be needed. This involves placing a breathing tube (known as a tracheostomy tube) through an opening in the windpipe. Sometimes a laser procedure to widen the airway may be used instead.