Vocal cord paralysis
Alerts and Notices
Synopsis

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.
Codes
ICD10CM:J38.00 – Paralysis of vocal cords and larynx, unspecified
SNOMEDCT:
302912005 – Vocal cord palsy
Look For
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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)
- Posterior glottic stenosis with vocal cord immobility
- Intubation injury
- Autoimmune vasculitis
Best Tests
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Management Pearls
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Therapy
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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.Subscription Required
References
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Last Reviewed:02/05/2019
Last Updated:10/17/2021
Last Updated:10/17/2021