Laryngeal nerve damage

Answer 1

Definition

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

Alternative Names

Vocal cord paralysis

Causes, incidence, and risk factors

Injury to the laryngeal nerves is uncommon.

However, it may occur from:

• A complication of neck or chest surgery (especially thyroid, lung, or heart surgery)
• A breathing tube in the windpipe (endotracheal tube)
• Tumors in the neck or upper chest, such as thyroid or lung cancer

Symptoms

• Difficulty speaking
• Difficulty swallowing
• Hoarseness

Injury to the left and right laryngeal nerves at the same time is an urgent situation that can lead to difficulty breathing.

Signs and tests

The doctor will see if the vocal cords move abnormally. Abnormal movement usually means that a laryngeal nerve is injured.

Tests may include:

• Bronchoscopy
• CT scan of the chest
• Laryngoscopy
• X-ray

Treatment

Treatment depends on the cause of the injury. In some instances, 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
• Injections of collagen, Gelfoam, or some other substance
• Thyroplasty

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

Expectations (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.

Calling your health care provider

Call your health care provider if you have:

• Difficulty breathing
• Unexplained hoarseness that lasts for more than 3 weeks

Answer 2

Definition

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

Alternative Names

Vocal cord paralysis

Causes, incidence, and risk factors

Injury to the laryngeal nerves is uncommon.

However, it may occur from:

• A complication of neck or chest surgery (especially thyroid, lung, or heart 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

Symptoms

• Difficulty speaking
• Difficulty swallowing
• Hoarseness

Injury to the left and right laryngeal nerves at the same time can be an urgent situation that can lead to difficulty breathing.

Signs and tests

The doctor will see if the vocal cords move abnormally. Abnormal movement may mean that a laryngeal nerve is injured.

Tests may include:

• Bronchoscopy
• CT scan of the chest
• Laryngoscopy
• MRI of the brain, neck, and chest
• X-ray

Treatment

Treatment depends on the cause of the injury. In some instances, 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.

Expectations (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.

Calling your health care provider

Call your health care provider if you have:

• Difficulty breathing
• Unexplained hoarseness that lasts for more than 3 weeks

References

Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: Cummings CW, Flint PW, Haughey BH, et al., eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 124.

Reviewed By

Review Date: 11/27/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.