Vocal Fold Paralysis
Vocal fold paralysis is the loss of movement in one or both vocal folds, usually because the nerve supplying the laryngeal muscles has been injured. It affects the voice, swallowing and, when both sides are involved, breathing.
What it is
Each vocal fold is moved by muscles supplied by the recurrent laryngeal nerve, which runs from the brain through the neck and into the chest before returning to the larynx. Injury anywhere along this long course can paralyse the fold on that side. When the nerve is weakened rather than cut, the result is paresis, a partial loss of movement.
Symptoms
- a weak, breathy voice that tires quickly
- running out of breath while speaking
- coughing or choking on liquids
- a weak cough
- in bilateral paralysis, noisy breathing and breathlessness on exertion
Causes
Surgery on the thyroid, neck, chest or heart; tumours along the nerve; viral illness; neurological conditions; and prolonged intubation. When the cause is not known, imaging along the course of the nerve is part of the assessment.
How it is diagnosed
Laryngoscopy and stroboscopy show which fold is affected, where it rests and how well the folds close. Laryngeal EMG, where helpful, assesses the nerve and the likelihood of recovery.
Treatment
The full range of options, from injection to reinnervation, and how we choose between them, is set out in our flagship program: Vocal Fold Paralysis and Laryngeal Reinnervation.
Medically reviewed by
Associate Professor Necati Enver, MD
Laryngologist · Founder and Director, Istanbul Voice Center · Reviewed September 2026
General information only. It does not replace an individual assessment. Medical disclaimer
Frequently asked questions
What causes vocal fold paralysis?
The commonest causes are injury to the nerve during surgery on the thyroid, neck or chest, tumours along the course of the nerve, viral illness, and neurological conditions. In some patients no cause is found.
Is vocal fold paralysis dangerous?
One-sided paralysis mainly affects the voice and can make swallowing liquids less safe. Paralysis of both vocal folds can narrow the airway and needs prompt specialist assessment.
What is the treatment?
Options include voice therapy, injection laryngoplasty, medialisation thyroplasty and laryngeal reinnervation. The choice depends on the cause, the time since injury and what the voice needs to do.
Need a specialist voice or laryngeal evaluation?
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