There are several methods for treating vocal fold paralysis, among them surgery and voice therapy. In some cases, the voice returns without treatment. For that reason, doctors often delay corrective surgery for a few months. During this time, the suggested treatment is usually voice therapy, which may involve exercises to strengthen the vocal folds or improve breath control during speech. Sometimes, a speech-language pathologist must teach patients to talk in different ways.
Surgery involves adding bulk to the paralyzed vocal fold. To add bulk, an otolaryngologist injects a substance into the paralyzed cord. Other substances currently used are collagen, a structural protein; silicone, a synthetic material; and body fat (lipoinjection). Gelfoam injections contain a gelatin powder mixed with saline, and effectively treats paralyzed vocal folds for 4 – 12 weeks. The added bulk reduces the space between the vocal folds so the nonparalyzed fold can make closer contact with the paralyzed fold and thus improve the voice.
Another method of adding bulk to the vocal fold is by cutting a small window in the throat through the thyroid cartilage, and then implanting a silicone block that is designed for the individual’s particular anatomy.
Sometimes a more complex operation that permanently shifts a paralyzed fold closer to the center of the airway may improve the voice. There are a number of ways that surgeons may perform such repositioning, depending on the individual’s condition. The surgeon may manipulate the arytenoid cartilage, the muscles of the vocal fold, the cricoarytenoid joint, or other parts of the larynx. Some procedures address the position and bulk of the vocal fold while others address the length and tension of the fold. Again, these operations allow the nonparalyzed fold to make better contact with the paralyzed fold. Adding bulk to the vocal fold or shifting its position can improve both voice and swallowing. After these operations, patients may also undergo voice therapy, which often helps to fine-tune the voice.
Treating people who have two paralyzed vocal folds may involve performing a surgical procedure called a tracheotomy to help breathing. In a tracheotomy, an incision is made in the front of the patient's neck and a breathing tube (tracheotomy tube) is inserted through a hole, called a stoma, into the trachea. Rather than breathing through the nose and mouth, the patient now breathes through the tube. Following surgery, the patient may need therapy with a speech-language pathologist to learn how to care for the breathing tube properly and how to reuse the voice.
Sources: This page was adapted in part from a patient handout sheet published by the National Institute on Deafness and Other Communication Disorders (NIDCD).