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Vocal cord paralysis
Other Resources UpToDate PubMed

Vocal cord paralysis

Contributors: Michael W. Winter MD, Paul C. Bryson MD, MBA
Other Resources UpToDate PubMed


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.


J38.00 – Paralysis of vocal cords and larynx, unspecified

302912005 – Vocal cord palsy

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Vocal cord paralysis is usually a symptom of something else. Causes include:
  • Viral infection (idiopathic) – Epstein-Barr virus, herpes simplex virus, Lyme disease
  • Iatrogenic from thyroid surgery, spine surgery, esophageal surgery, carotid surgery, mediastinal surgery, or neurosurgery due to injury to the recurrent laryngeal nerve
  • Iatrogenic from intubation and subsequent nerve compression
  • Cerebrovascular injury
  • Neurodegenerative disorder – amyotrophic lateral sclerosis, suprabulbar palsy, multisystem atrophy
  • Head / neck malignancy with neurologic invasion (see, eg, laryngeal cancer)
  • Skull base neoplasm
  • Laryngeal trauma (blunt and penetrating)
The differential also includes:
  • Posterior glottic stenosis with vocal cord immobility
  • Intubation injury
  • Autoimmune vasculitis

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:02/05/2019
Last Updated:10/17/2021
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Vocal cord paralysis
A medical illustration showing key findings of Vocal cord paralysis : Hoarseness, Dysphagia, Dyspnea, Difficulty speaking, Stridor
Copyright © 2023 VisualDx®. All rights reserved.