How to Diagnose Vocal Cord Paralysis

Vocal cord paralysis, formally known as Unilateral Vocal Fold Paralysis, is a dysfunction of the recurrent laryngeal nerve or vagus nerve that stimulates the larynx. The normal speaking voice can usually be restored with proper evaluation and treatment.

Instructions

1. Observe the first symptoms of Unilateral Vocal Fold Paralysis. These patients initially present with a characteristic breathy, low-pitched voice in most cases. However, the voice also may be high-pitched because of a compensated falsetto.

2. Examine the patient for shortness of breath, especially when speaking. This is primarily because of air wasting caused by dysfunction of the glottis rather than any significant impact on pulmonary function.

3. Check the patient history for any recent chest, head or neck surgery. The most common cause of Unilateral Vocal Fold Paralysis is a surgical injury to the laryngeal or vagus nerve. This specifically includes procedures such as anterior spinal surgery, a carotid endartectomy, a thyroidectomy, thoracic or mediastinal surgeries.

4. Perform chest radiography as the first imaging study. Unilateral Vocal Fold Paralysis can also be caused by a mass in the chest such as a large cardiomegaly, mediastinal mass or Pancoast tumor that enlarges the left atrium to the point that it damages the left recurrent laryngeal nerve.

5. Conduct a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) scan if the chest radiography is negative. The entire path of the vagus and recurrent laryngeal nerves should be examined for injuries, requiring imaging from the bottom of the skull to the aortic arch for the left nerves and the clavicle for the right nerves.