Q: My left vocal cord has been paralyzed since December 2006. I have gone to voice therapy a few times but it is not working. I am a business owner and need my voice.
Is the surgery where doctors move your cord over an effective procedure? A: Thank you for the question. I do not know the degree of your paralysis, so I cannot completely answer the question but here are a few general points that may help: Make sure you have had a workup for the cause of left cord paralysis (unless you know the cause, such as secondary to a prior surgery).
My choice of a basic work-up for left cord paralysis includes a head and neck exam, as well as a brain, neck and chest CT (down to the aortic arch). For a right vocal cord paralysis, the chest CT is not needed. This assumes you do not have any other medical conditions; if you do, other tests may be indicated.
If the vocal cord stays paralyzed for over six months, it is very likely that it will not come back. The length of paralysis will help choose the treatment. The treatment choice also depends on your symptoms.
For example, is your main complaint a breathy voice that fatigues easily, or do you also choke on liquids? If a breathy, fatigued voice is the main problem, pushing over the cord improves the voice in the vast majority of the cases. This therapy will improve both the breathy component and the fatigue, although it has more impact on the former.
Two types of treatment are used to push the cord over: - The first involves a temporary injection (usually lasts 3-9 months, depending on the material). There are many materials that can be used. - The second treatment uses a surgically placed implant to push the cord over.
For patients under 6-7 months of paralysis, I usually do a temporary injection; for greater than 6-7 months I usually do a more permanent procedure. If choking is an issue, or if just pushing it over does not get a great result, there are operations, such as an "arytenoid adduction" that can help. Another alternative treatment is reinnervation.
This is where a nerve, called the ansa cervicalis, is used to reinnervate the larynx. For certain patients, I have found this operation to produce a great voice, but this is a less common operation. Today's answer is from Dr.
Siddarth M. Khosla, an assistant professor in the Department of Otolaryngology at the University of Cincinnati College of Medicine. NetWellness, a collaboration of the University of Cincinnati, Ohio State University and Case Western Reserve University, is a consumer health information Web site.
Submit questions through the site, www.netwellness.org .
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