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Vocal cord palsy fact sheet

Vocal cord palsy

What is vocal cord palsy?

The vocal cords are two bands of tissue that sit at the opening of the trachea (windpipe) within the larynx (voice box). The vocal cords open to allow airflow in and out of the lungs during breathing. They close together to produce vibrations (sound) used for speaking.  They also close during swallowing to prevent food or fluid from entering the windpipe and lungs.

Vocal cord palsy (VCP) is a condition in which the vocal cords cannot move, or have weak or reduced movement, on one or both sides.

vocal cord positions

What causes vocal cord palsy?

Vocal cord palsy can be congenital (present at birth) or acquired later in childhood. The recurrent laryngeal nerve (RLN) may be damaged during childbirth, or during surgery particularly involving the heart and lungs or the oesophagus (food pipe). Some neurological (brain and nerve) conditions and infections may also affect the RLN. It is rare, but this nerve can be affected by the pressure of a mass in the neck.  In some children, no cause can be identified and this is known as ‘idiopathic’ vocal cord palsy.

Vocal cord palsy may lead to:

  • ‘Squeaky’ or noisy breathing (stridor)
  • A breathy, weak voice
  • A hoarse, quiet or silent cry in infants
  • Food or fluids entering the windpipe or lungs during swallowing (aspiration)

How is it assessed?

If there are concerns after surgery that your child may have VCP then you will be referred to an Ear Nose and Throat specialist (ENT). They will often look at your child’s vocal cords with an instrument called a ‘scope’ to assess how the vocal cords are moving.

How is it treated?

In most cases, no immediate treatment is required, however your child may need help to prevent food or fluid ‘going down the wrong way’ into the windpipe.

Over time, some children may have spontaneous improvement in their vocal cord movement (with improvement in their voice and swallowing) due to:

  • recovery of the nerve controlling the affected vocal cord
  • the unaffected vocal cord compensating for the weaker cord

It is difficult to predict how much recovery will occur, or how long this recovery will take.  The ENT team can discuss this further with you.

Can my child breast/bottle feed, or eat and drink?

Children with vocal cord palsy can be assessed by a Speech Pathologist and supported to develop or recommence oral feeding wherever possible. Speech Pathology treatment will focus on strategies to keep your child safe, and prevent fluid or food entering the airway during breast or bottle feeding, or while eating and drinking.

What can I do to help my child’s voice?

The ENT surgeon may refer your child to a Speech Pathologist for voice therapy which involves play based exercises to help them with breath control and to use their voice effectively. Home based follow up and advice about looking after your voice are important aspects of voice improvement. This process is reviewed by the ENT and Speech Pathologist in the Voice Clinic where the scope may be used again to check how the vocal cords are working during speech production.

Useful links

Contact your Speech Pathologist or ENT if you have any questions or concerns about your child’s vocal cord function or feeding and swallowing.

Contact us

Speech Pathology Department
Level 6a, Queensland Children’s Hospital
501 Stanley Street, South Brisbane QLD 4101
t: 07 3068 2375

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Resource No: FS339. Developed by the Speech Pathology Department Queensland Children’s Hospital. Updated: January 2019. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.