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Laryngeal nerve damage

Vocal cord paralysis

Laryngeal nerve damage is injury to one or both of the nerves that are attached to the voice box.

Causes

Injury to the laryngeal nerves is uncommon.

When it does occur, it can be from:

  • A complication of neck or chest surgery (especially thyroid, lung, heart surgery, or cervical spine surgery)
  • A breathing tube in the windpipe (endotracheal tube)
  • A viral infection that affects the nerves
  • Tumors in the neck or upper chest, such as thyroid or lung cancer
  • Part of a neurological condition

Symptoms

Symptoms include:

  • Difficulty speaking
  • Difficulty swallowing
  • Hoarseness

Injury to the left and right laryngeal nerves at the same time can cause a breathing problem. This can be an urgent medical problem.

Exams and Tests

The health care provider will check to see how your vocal cords move. Abnormal movement may mean that a laryngeal nerve is injured.

Tests may include:

Treatment

Treatment depends on the cause of the injury. In some cases, no treatment may be needed and the nerve may recover on its own. Voice therapy is useful in some cases.

If surgery is needed, the goal is to change the position of the paralyzed vocal cord to improve the voice. This can be done with:

  • Arytenoid adduction (stitches to move the vocal cord toward the middle of the airway)
  • Injections of collagen, Gelfoam, or another substance
  • Thyroplasty

If both the left and right nerves are damaged, a hole may need to be cut into the windpipe (tracheotomy) right away to allow breathing. This is followed by another surgery at a later date.

Outlook (Prognosis)

The outlook depends on the cause of the injury. In some cases, the nerve rapidly returns to normal. However, sometimes the damage is permanent.

When to Contact a Medical Professional

Call your provider if you have:

  • Difficulty breathing (call right away)
  • Unexplained hoarseness that lasts for more than 3 weeks

References

Dexter EU. Perioperative care of the thoracic surgical patient. In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston and Spencer Surgery of the Chest. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 4.

Sandhu GS, Nouraei SAR. Laryngeal and esophageal trauma. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 67.

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    • Nerves of the larynx

      Nerves of the larynx

      illustration

    • Laryngeal nerve damage

      Laryngeal nerve damage

      illustration

      • Nerves of the larynx

        Nerves of the larynx

        illustration

      • Laryngeal nerve damage

        Laryngeal nerve damage

        illustration

       

      Review Date: 11/4/2018

      Reviewed By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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