Vocal Hoarseness

Vocal Cord Polyps

These are usually one-sided but can occasionally be on both sides. Risk factors include vocal abuse and smoking. This lesion can be easily dealt with by a use of a laser to excise the polyps. Postoperatively, speech therapy is required.

Fleshy polyp arising form the right vocal cord

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The list of causes of a vocal cord paralysis includes infections, tumours, metabolic conditions, inflammatory diseases, following surgery in the head and neck and chest, trauma to the neck, head injury, and vascular causes such as having a stroke.

There are a variety of operative procedures that have been described which can allow the vocal cord to travel to the midline and improve the voice.

Vocal Cord Paralysis

The vocal cords have a curious nerve supply. The nerve that controls the vocal cord starts in the brain and travels through the neck. On the left side, it descends down into the chest and winds itself around the bronchus before travelling upwards into the neck and supplying the muscles on the left side of the larynx. On the right side however, the nerve merely travels from the brain to the neck itself. For this reason, paralysis of the left vocal cord is more common particularly after conditions that affect the chest such as lung cancer. However, 80% of patients presenting with hoarseness due to a paralysed vocal cord are described as idiopathic, meaning that no obvious cause has been found.

Typically, the patient presents with a hoarse voice and associated cough. Occasionally, patients have coughing bouts during meals as food and drink goes down the windpipe. There is often a typical breathy voice, which is characteristic of vocal cord palsy. Diagnosis is made by clinical examination with fibre-optic endoscopy where one vocal cord is seen to be immobile. Management includes complete head and neck examination together with imaging from the base of the skull right down to the middle of the chest. This is done by CT and/or MRI. Any suspicious areas will need to be biopsied. If the cause is idiopathic, then speech therapy may be helpful in regaining some functionality and indeed in many instances this is spontaneous. However, in those patients in whom the recovery is not complete and the patients are symptomatic, then augmentation of the vocal cord by injecting it with an inert material is often helpful.

In very rare instances, the vocal cord palsy can be bilateral. This is often a medical emergency as the airway is compromised. The commonest cause is usually due to thyroid surgery when the recurrent laryngeal nerves have been cut inadvertently or perhaps necessarily in the presence of thyroid cancer. Once established, the patient will need to have excision of part of the larynx in order that the airway can be improved but this is usually at the expense of voice quality.

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