What are the symptoms of vocal fold disease?

Paralysis of the vocal fold muscles can manifest itself in very different ways.

Paralysis of the vocal fold muscles can manifest itself in very different ways. The most common symptom of unilateral vocal fold paralysis is hoarseness. The voice sounds a little hoarse and raspy. Speaking is also much more strenuous for the patient, as an excessive amount of air is exhaled. This is because vocal fold paralysis is also accompanied by a lack of glottal closure. However, complete vocal fold closure is important for speech. When speaking, the normal speaking voice is produced in such a way that – similar to a woodwind instrument – a large amount of air pressure is required to produce the normal speaking voice. If the glottis is too wide, much more air than usual is passed through the glottal slit. As a result, those affected experience voice fatigue much more quickly after speaking for a long time. Respiratory problems can also be present in vocal fold paralysis. Too little air on exertion, noisy breathing (stridor) and ineffective or weak coughing. Another symptom of vocal fold paralysis is diplophonia. This means that the voice sounds as if it were gurgling. It is not uncommon for vocal fold paralysis to cause swallowing problems. Swallowing food, drinks or even saliva can then cause coughing.

What is vocal fold paresis?

The paralysis (paresis) of the vocal folds results from incorrect nerve signals to the muscles of the larynx (laryngeal muscle). Vocal fold paralysis can affect you at any age, from birth to old age. Women and men are equally affected, and the causes are manifold. The impact on those affected varies and depends on their occupation. A weak vocal cord paralysis can mean the end of a singer’s career, but has virtually no effect on the work of a programmer.

What are the causes of vocal fold paralysis?

The causes of the paralysis can indicate whether the dysfunction is only temporary or permanent. If the cause is reversible, surgical treatment is usually not recommended due to the likelihood of a quick recovery. Despite advances in diagnostic techniques, in half of all cases of vocal cord paralysis, specialists are unable to identify the cause. Due to the unknown cause, these cases are referred to as “idiopathic”. In idiopathic vocal fold paralysis, the disease could be the result of viral infections of the laryngeal nerves (recurrent laryngeal nerve and superior laryngeal nerve) or the vagus nerve, although this cannot be proven in most cases. Known causes of the disease are

(1) Viral infections: Inflammation caused by viruses could spread to the vagus nerve or its branches to the larynx (recurrent laryngeal nerve and superior laryngeal nerve) and injure them. Systemic diseases – i.e. diseases that affect the entire organism and impair the nerves in the body – can also affect the laryngeal nerves.
(2) Tumors of the skull base, neck and chest: Tumors, whether benign or malignant, can grow around the nerves and exert pressure on the nerves. This can lead to various types of paralysis.
(3) Accidental injury during the operation: Operations in the neck or chest area could unintentionally result in recurrent nerve palsy (paralysis of the recurrent laryngeal nerve). Recurrent paresis can generally occur during operations in the head, at the base of the skull and on the side of the neck.
(4) Complications of endotracheal intubation: Recurrent nerve injuries can also occur when the breathing tubes (intubation tubes) are used for anesthesia and/or artificial respiration. However, this type of injury is rare, given the frequency of operations under anesthesia.
(5) Blunt neck or chest trauma: Any type of deep, hard impact to the neck and chest area could injure the recurrent laryngeal nerve. Very strong impacts and blows to the neck, for example after accidents, can also injure the recurrent laryngeal nerve.

Which nerves are affected by vocal fold paresis?

The movements of the vocal folds are the result of coordinated contractions of various muscles. These are controlled by the brain through certain nerves. The following nerves receive signals:

The superior laryngeal nerve, which transmits the signals to the cricothyroid muscle, is located between the cricoid cartilage and the thyroid cartilage. As the cricothyroid muscle determines the tension of the vocal cords for high notes during singing, paralysis of the superior laryngeal nerve results in a change in vocal pitch and can cause problems when singing, which are particularly noticeable when intoning higher notes with a soft transition. In some cases, patients with vocal fold paralysis can speak normally but only sing with distortion.

The recurrent laryngeal nerve (Nervus laryngeus recurrens) transports signals to the laryngeal muscles, which open and close the vocal folds when breathing or coughing, so that the vocal cords vibrate and speech can be produced. The recurrent laryngeal nerve is also important for the swallowing function. The recurrent laryngeal nerve runs from the neck down into the chest cavity and from there back into the neck to the larynx. Due to its length and because it is connected to the larynx via a “detour”, there are many reasons for injuries. Infections and tumors of the brain, neck, chest or larynx, as well as complications from operations in the head, neck or chest can injure, stretch or put pressure on the nerve. Consequently, the recurrent laryngeal nerve is involved in most cases of vocal cord paralysis and paresis. As the recurrent laryngeal nerve is the only nerve that supplies the internal laryngeal muscles for vocal cord opening, paralysis of a recurrent laryngeal nerve leads in particular to vocal fold arrest. The vocal fold is then almost in the midline. This is noticeable in the patient through hoarseness.

How is vocal fold paralysis diagnosed?

The ENT specialist will carry out a full examination and then question you about your symptoms and lifestyle (voice use, alcohol/tobacco consumption). The examination of the larynx is carried out to determine whether one or both vocal cords (vocal folds) are affected. Determining this is important for further treatment. However, further investigations may also be necessary, as there is a very long list of diseases that can result in nerve damage. These tests include blood tests, X-rays, CT scans, MRIs and endoscopic examinations under anesthesia.

What treatment options are there for the vocal folds?

The two treatment strategies to improve speech function are voice therapy, the equivalent of physical therapy for large muscle paralysis, and phonosurgery, a procedure in which the vocal cords are repositioned and trimmed to improve vocal function. Voice therapy is usually the first step in treatment. Once this therapy has been completed, the decision on surgical intervention is made depending on the severity of the symptoms, the patient’s voice requirements, the position of the paralyzed vocal cords, the prospect of recovery and the cause of the paralysis.
In principle, any hoarseness that lasts longer than four weeks should be clarified by an ENT specialist.

Frequently asked questions

Here we answer the most frequently asked questions

Which medications have dry mouth as a side effect?2024-04-15T08:59:15+02:00

High blood pressure medication, antidepressants and opioids can lead to
lead to dry mouth. However, dry mouth can also be caused by
medication can be strengthened.

What symptoms can occur when the mouth is dry?2024-04-15T08:59:15+02:00

The flow of saliva is important for the mucous membranes of the mouth
and throat. If too little saliva is produced, this can lead to noticeable and
disturbing changes in the oral mucosa: Taste disturbances,
Changes in speech, dry mouth, burning tongue, dry mouth
Lips, bad breath and difficulty swallowing.

What is the cause of a cholesteatoma?2024-04-15T08:59:15+02:00

A cholesteatoma is often caused by an inflammation of the middle ear or a malfunction of the Eustachian tube. This usually results in negative pressure in the middle ear. A so-called epitympanal retraction of the eardrum can occur.

Normally, the Eustachian tube conducts air from the back of the nose into the middle ear. This regulates the normal pressure in the middle ear. An allergic reaction, a cold, a cleft lip and palate, radiation or sinusitis can impair the normal function of the Eustachian tube. A vacuum can develop in the middle ear. The vacuum created sucks in parts of the eardrum that have been weakened by inflammation. This can then be the precursor of a cholesteatoma. Very rarely, there are also congenital cholesteatomas. However, the most common cause of cholesteatomas is ear infections.

Can I park in front of the practice?2024-04-15T08:59:13+02:00

Parking spaces are now available free of charge at the HNO-Center Lucerne. Just ask about the new parking facilities behind the practice if you have an appointment during consultation hours. We will be happy to help you.

Are the operations at the practice on Hünenbergstr. carried out?2024-04-15T08:59:09+02:00

In the practice on Hünenbergstr. we have a practice operating theater that we only use for minor procedures. In principle, we perform all surgical procedures either as outpatients at the Villa Eiche Day Clinic or as inpatients at the Obwalden Cantonal Hospital.

What treatment options are there for dry mouth?2024-04-15T08:59:15+02:00

First of all, the exact diagnosis must be determined. When
another disease is the cause of the dry mouth, the first thing to do is to
the other disease can be treated. If you have diabetes mellitus, you must
the blood sugar level must be adjusted first. If there is a
nasal septum curvature is present, then you should consult a specialist for
Ear, nose and throat diseases discussed about a nasal partition correction
become. Drinking plenty of fluids also has a positive effect, as does the
Use of a humidifier. In the case of nicotine consumption, nicotine consumption should also be
be stopped.

How can Sjögren’s syndrome be diagnosed?2024-04-15T08:59:14+02:00

The body produces antibodies that can be detected in the blood. The antibodies against Sjögren’s syndrome can be determined with a blood test.
(SS-A and SS-B antibodies). Through a microscopic examination
a tissue sample taken from the inside of the lips, the specialist for
ear, nose and throat diseases can prove the diagnosis of Sjögren’s syndrome.

What are the causes of dry mouth?2024-04-15T08:59:13+02:00

The causes of dry mouth can vary.
As part of the natural ageing process, the number and quality of
of the saliva-producing cells. Obstructed nasal breathing can also be a
Increase dry mouth. Occasionally, dry mouth is also a
Symptom of another disease. Saliva production may be reduced
for autoimmune diseases, diabetes mellitus, hepatitis C,
Parkinson’s disease, Alzheimer’s disease and HIV. Also hormonal causes (menopause)
or nicotine abuse can lead to a dry mouth. In Sjögren’s syndrome
dry mouth is often accompanied by dry eyes.

What do I do if I have an enlarged thyroid?2024-04-15T08:59:15+02:00

Sometimes nodules can develop in the thyroid gland. The growth
the knot can sometimes be slow or fast. Patients who have a
have undergone radiotherapy in the head or neck area are particularly prone to
to develop thyroid disease. If the nodes are
growth, it is usually advisable to surgically remove the
thyroid gland.

A thyroid dysfunction or a thyroid nodule is called
diagnosed by taking a medical history and performing an examination.
is carried out. In particular, your doctor will examine your throat and
ask you to lift your chin to allow the thyroid gland to protrude more.
During the examination you will be asked to swallow, which will
helps to feel the thyroid gland and the nodules in it. Depending on
If necessary, arrange for further investigations. In most cases, an ultrasound examination
of your neck and thyroid and laboratory tests of the thyroid gland.
blood to check thyroid function. Likewise, a
thyroid scintigraphy with radioactive iodine may be necessary. Your
doctor performs a fine-needle examination of the thyroid gland, an X-ray examination of the
chest or, in rare cases, computerized tomography or MRI examination for
consider necessary

What are the treatment options for snoring?2024-04-15T08:59:14+02:00

Uvulo-palato-pharyngoplasty (UPPP) is a surgical procedure that is used to treat severe snoring caused by sleep apnea. The procedure is based on shortening the loose tissue of the palate, in particular the elongated uvula (uvula of the palate). The aim of the operation is to tighten the soft palate on the one hand and to shorten the soft palate while preserving the natural soft palate muscle (uvulae muscle) on the other. The front of the mucous membrane of the uvula is removed and sutured to the palate in such a way that the uvula is shortened. As a result, the uvula no longer rests on the base of the tongue. This expands the air passage. The procedure is associated with a short inpatient stay of one to three days. In very rare cases, risks may occur during this procedure. These risks include infections, bleeding, impaired wound healing, post-operative bleeding, speech impairment in the form of open nasal passages, dental damage, temporary to permanent difficulty swallowing and the very rare risk of thrombosis (embolism) during an operation under anesthesia. The ability to swallow is restricted for around 14 days after the procedure, as pain may occur. The pain will be easily treatable with medication. Antibiotic treatment is typically not necessary. In addition to these surgical measures, accompanying, non-surgical measures should be considered by the patient. In addition to these measures, it is important to maintain a healthy and sporty lifestyle in order to achieve good muscle tone and reduce weight. Medication that causes drowsiness, such as sedatives, sleeping pills or antihistamines, should no longer be taken at night. Alcohol should also be avoided as a matter of principle. You should also sleep on your side rather than on your back. A slight tilt of the head upwards usually has a positive effect. A normal sleep rhythm is just as beneficial. Alcohol should be avoided about 4 hours before going to bed and heavy meals about 3 hours before.

Are nasal tamponades inserted during nasal surgery?2024-04-15T08:59:08+02:00

In principle, the insertion of nasal tamponades is not necessary when correcting the nasal septum or correcting the outer nose. How long will I be unable to work after a rhinoplasty? In the case of rhinoplasty surgery or correction of the nasal septum, the patient is usually unable to work for around 14 days.

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