Vocal cord paralysis is a condition characterized by injury to the nerves that innervate the vocal cords. This injury can either be unilateral or bilateral. It can occur as a result of trauma to the recurrent laryngeal nerve, which commonly occurs as a complication of surgery or as the result of a neoplastic process. There is also an idiopathic etiology. Less commonly, progressive neurologic disorders such as multisystem atrophy or suprabulbar palsy can result in dysfunction of the recurrent laryngeal nerve and resultant vocal cord paralysis. Certain infections, such as Lyme disease, Epstein-Barr virus, and herpes viruses, can manifest with nerve inflammation that can cause either unilateral or bilateral vocal cord paralysis.

In adults, vocal cord paralysis may present as dysphonia, hoarseness, dysphagia, and conversational dyspnea. Infants and children may present with weak cry, stridor, cough, hoarseness, and respiratory insufficiency. Neonates can rarely develop vocal cord paralysis secondary to nerve damage during delivery.

Treatment and prognosis for recovery depend on cause and time from onset as some underlying etiologies can recover spontaneously while others are permanent. Bilateral vocal cord paralysis results in stridor and airway compromise. These patients will often require re-intubation and consideration of a surgical tracheostomy for airway safety.