Dysphonia & Vocal Cord Paralysis

Diagnosis starts with a comprehensive physical exam by our neuro-laryngology experts. We will review your medical history and symptoms. Symptoms might include: 

• Breathy vocal quality 
• Frequent coughing or choking when swallowing 
• Frequent throat clearing 
• Hoarseness 
• Loss of the gag reflex 
• Loss of pitch 
• Low or quiet voice 
• Noisy breathing 
• Shortness of breath when speaking 

Next, we will perform a speech evaluation to assess your baseline breathing, swallowing and speech. Depending on your symptoms, you may be diagnosed with one of the two main types of dysphonia: 

• Vocal cord paralysis – Nerve impulses to your larynx (voice box) are interrupted by a neurological condition or damage to the nerves from trauma, tumor or infection. One or both vocal cords can be affected.   
• Spasmodic (laryngeal) dysphonia – The vocal cords have sudden involuntary spasms that interfere with the ability to produce controlled sound for speech. Most cases of spasmodic dysphonia are caused by neurological disorders of the brain and/or peripheral nerves.

Houston Methodist offers advanced testing and technologies to determine the cause of your condition. Tests will vary depending on your history and symptoms and may include: 

• Speech evaluation by a speech-language pathologist  
• Evaluation for any neurological or movement disorders that may affect your speech, such as dystonia or Parkinson’s disease  
• Blood tests 
• Examination of your vocal cords using an endoscopeor a mirror to decide the position and movement of your vocal cords 
• Imaging scans, such as CT or MRI 
• Laryngeal electromyogram, in which electrodes placed into the vocal cord muscles measure the electrical currents of those muscles (rarely needed)

Though some cases are temporary, dysphonia can be a life-long, chronic condition. It can be caused by: 

• Overuse of your voice (screaming) 
• Excessive throat clearing 
• Substance use (smoking or alcohol) 
• Physical abnormality (nodules, polyps or inflammation) 
• Trauma or injury 
• Stroke  
• Tumor  
• Infection 
• Neurological disorders, such as Parkinson’s disease or dystonia 

It takes an experienced team to effectively treat or manage dysphonia. Houston Methodist offers leading-edge treatment options, backed by research and the combined expertise of our specialized team. We will work together to design a personalized care plan to fit your needs.  

While there is no cure for dysphonia yet, specialized care can significantly reduce symptoms. Treatment options depend upon the cause, severity and duration of symptoms. Recommended treatments may include:  

• Speech therapy 
• Medication 
• Injections of botulinum toxin (Botox®) into the affected muscles 
• Collagen or filler injections to bulk up the cord 
• Surgery, such as structural implants, nerve repair or vocal cord repositioning 

In severe cases, patients find that a mechanical speech device can help improve communication and quality of life.