speech therapy exercises for paralyzed vocal cord

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Vocal Fold Paralysis

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About Vocal Fold Paralysis

Signs of vocal fold paralysis, causes of vocal fold paralysis, testing for vocal fold paralysis, treatment for vocal fold paralysis, other resources.

Your vocal folds are inside your larynx, or voice box. When you talk, air moves from your lungs through the vocal folds to your mouth. The vocal folds vibrate to produce sound. Anything that makes it harder for the vocal folds to vibrate can cause a voice problem. Vocal fold paralysis happens when one or both vocal folds are not able to move. It can also cause breathing and swallowing problems.

There are different types of vocal fold paralysis. Bilateral vocal fold paralysis means that both vocal folds will not move. People with this condition may need a tracheotomy if the vocal folds are close to a closed position which interferes with breathing. A tracheotomy is an opening made in the neck. They breathe through this opening.

Unilateral vocal fold paralysis is when only one fold will not move or only moves a little bit. It is more common than bilateral paralysis. The paralyzed vocal fold does not vibrate with the other fold. The person’s voice will not sound clear or loud. They may run out of air when speaking.

Vocal fold paralysis can cause problems that are mild or severe. Some signs include:

• Breathy voice
• Being unable to speak loudly
• Limited pitch and loudness
• Being able to produce voice for a very short time
• Choking or coughing while eating
• Possible pneumonia if food and liquid get into the lungs. This may happen if the vocal folds cannot close to protect the airway while swallowing.

Nerve damage causes vocal fold paralysis. The vagus nerve runs from the brainstem to the larynx. This nerve controls vocal fold movement. Anything that damages this nerve can cause paralysis. This includes head and neck injuries, tumors, disease, surgery, or stroke.

You should see your doctor if you have trouble with your voice. You may want to see an otolaryngologist, or ear, nose, and throat doctor, who knows about voice problems. A speech-language pathologist, or SLP, can test how your voice sounds. The SLP or doctor can look at your vocal folds through a tube that goes into your mouth or nose, called an endoscope. A flashing light, called a stroboscope, lets the team watch your vocal folds move.

Bilateral paralysis requires medical treatment. You may need to have a tracheotomy so you can eat safely. You might have surgery to bring one or both vocal folds closer to the middle.

You may need medical treatment for unilateral paralysis. This might include muscle-nerve transplant or surgery to move the paralyzed fold toward the middle. You might also have something injected into the fold to make it larger. This allows the other fold to move closer to it and may help your voice.

Voice therapy can also help unilateral paralysis. You can work with an SLP on changing your pitch and getting more breath support to speak louder. Changing your head position or pushing on your larynx may help your voice. Your doctor may want you to try voice therapy before you look into surgery or other medical treatments. It may be the only treatment that you need.

See ASHA information for professionals on the Practice Portal's Voice Disorders page.

To find a speech-language pathologist near you, visit ProFind .

This list does not include every website on this topic. ASHA does not endorse the information on these sites.

• Academy of Otolaryngology–Head and Neck Cancer Vocal Cord Paralysis information
• View video examples of vocal cord paralysis

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• Patient Care & Health Information
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• Vocal cord paralysis

To diagnose vocal cord paralysis, your healthcare professional asks about your symptoms and lifestyle. Your care professional also listens to your voice and asks how long you've had voice changes. You also may need the following tests:

Laryngoscopy. Your healthcare professional looks at your vocal cords using a mirror or a thin, flexible tube known as a laryngoscope or endoscope, or both. You also may have a test called videostrobolaryngoscopy. It uses a special scope that contains a tiny camera at its tip or a larger camera connected to the scope's viewing piece.

These special high-magnification endoscopes allow your healthcare professional to view your vocal cords directly or on a video monitor. The tests reveal the movement and position of the vocal cords. This can tell your healthcare professional whether one or both vocal cords are affected.

Laryngeal electromyography. This test measures the electrical currents in your voice box muscles. To do this, small needles are inserted into the vocal cord muscles through the skin of the neck.

This test isn't used to guide treatment, but it may give an estimate about how well you may recover. This test is most useful when it's done between six weeks and six months after your symptoms began.

• Blood tests and scans. Several diseases may cause nerve injuries. You may need additional tests to find the cause of the paralysis. Tests may include bloodwork, X-rays, MRI or CT scans.

More Information

• Electromyography (EMG)
• Upper endoscopy

Treatment of vocal cord paralysis depends on the cause, how serious the symptoms are and when symptoms began. Treatment may include voice therapy, bulk injections, surgery or a combination of treatments.

In some instances, you may get better without surgical treatment. For this reason, your healthcare team may delay permanent surgery for at least a year from the beginning of your vocal cord paralysis.

However, surgical treatment with various bulk injections is often done within the first three months of voice loss.

During the waiting period for surgery, you may get voice therapy to help keep you from using your voice improperly while the nerves heal.

Voice therapy

Voice therapy sessions involve exercises or other activities to strengthen your vocal cords and help improve breath control during speech. Voice therapy also can prevent tension in muscles around the paralyzed vocal cord or cords, and protect your airway during swallowing. Voice therapy may be the only treatment needed if the paralysis occurs in an area that doesn't require additional bulk or repositioning.

If your vocal cord paralysis symptoms don't fully recover on their own, you may need surgery to improve your ability to speak and to swallow.

Surgical options include:

• Bulk injection. Paralysis of the nerve to your vocal cord will probably leave the vocal cord muscle thin and weak. A doctor who specializes in disorders of the larynx, known as a laryngologist, may add bulk to the paralyzed vocal cord. This is done by injecting the vocal cord with a substance such as body fat, collagen or another approved filler substance. This added bulk brings the affected vocal cord closer to the middle of the voice box. Then the functioning vocal cord can make closer contact with the paralyzed cord when you speak, swallow or cough.
• Structural implants. This procedure relies on the use of an implant in the larynx to reposition the vocal cord. The procedure also is known as thyroplasty, medialization laryngoplasty or laryngeal framework surgery. Rarely, people who have this surgery may need to have a second surgery to reposition the implant.
• Vocal cord repositioning. In this procedure, a surgeon moves a window of your own tissue from the outside of your voice box inward, pushing the paralyzed vocal cord toward the middle of your voice box. This allows your functioning vocal cord to better vibrate against the paralyzed vocal cord.
• Replacing the damaged nerve, known as reinnervation. In this surgery, a healthy nerve is moved from a different area of the neck to replace the damaged vocal cord. It can take as long as 6 to 9 months before your voice gets better. This surgery is sometimes combined with a bulk injection.

Tracheotomy. If both of your vocal cords are paralyzed and positioned closely together, your airflow will be decreased. This causes a lot of trouble breathing and requires a surgery called a tracheotomy.

A cut is made in the front of your neck to create an opening in the windpipe, also known as the trachea. A breathing tube is inserted, allowing air to bypass the vocal cords.

Emerging treatments

Linking the vocal cords to another source of electrical stimulation may restore opening and closing of the vocal cords that can't move. Other sources of electrical stimulation might be a nerve from another part of the body or a device similar to a cardiac pacemaker. Researchers continue to study this and other options.

Coping and support

Vocal cord paralysis can be frustrating and affect your daily life. It can be hard to communicate with other people. A speech therapist can help you develop the skills you need to communicate.

Even if you're not able to get back the voice you once had, voice therapy can help you learn effective ways to make up for it. In addition, a speech-language pathologist can teach you how to use your voice without causing further damage to the vocal cords.

Preparing for your appointment

You're likely to first see your healthcare professional about vocal cord paralysis. But if both vocal cords are paralyzed, you'll probably first be seen in a hospital emergency department.

After the initial assessment, you'll likely be referred to a doctor who specializes in ear, nose and throat conditions. You also may be referred to a speech-language pathologist for voice assessment and therapy.

It's helpful to arrive well prepared for your appointment. Here's some information to help you get ready and what to expect.

What you can do

• Write down any symptoms you're experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent illnesses or life changes.
• Make a list of all medicines, vitamins or supplements that you're taking, including the dose of each.
• Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who is with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare professional may be limited. Preparing a list of questions can help you make the most of your time together. For vocal cord paralysis, some basic questions to ask include:

• What's the most likely cause of my vocal cord paralysis?
• What kinds of tests do I need? Do these tests require any special preparation?
• Is this condition temporary, or will my vocal cords always be paralyzed?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the treatment that you're suggesting?
• Are there any restrictions on using my voice after treatment? If so, for how long?
• Will I be able to talk or sing after treatment?
• Are there any brochures or other printed material that I can take home with me?

In addition to the questions that you've prepared to ask, don't hesitate to ask any additional questions that occur to you during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you a number of questions, such as:

• When did your symptoms start?
• Did any special events or circumstances happen before or at the same time that your symptoms developed?
• Have you received any treatment yet?
• Have your symptoms been continuous or do they come and go?
• How are your symptoms affecting your lifestyle?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do you have any other medical conditions?
• Lechien JR, et al. Management of bilateral vocal fold paralysis: A systematic review. Otolaryngology — Head and Neck Surgery. 2024; doi:10.1002/ohn.616.
• Vocal fold paralysis. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/vocal-fold-paralysis. Accessed May 18, 2022.
• Vocal fold paralysis. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/Vocal-Fold-Paralysis. Accessed May 18, 2022.
• Doherty GM, ed. Otolaryngology: Head & neck surgery. In: Current Diagnosis & Treatment: Surgery. 15th ed. McGraw Hill; 2020. https://accessmedicine.mhmedical.com. Accessed May 18, 2022.
• Bruch JM, et al. Hoarseness in adults. https://www.uptodate.com/contents/search. Accessed May 18, 2022.
• Ryu CH, et al. Guidelines for the management of unilateral vocal fold paralysis from the Korean Society of Laryngology, Phoniatrics and Logopedics. Clinical and Experimental Otorhinolaryngology. 2020; doi:10.21053/ceo.2020.00409.
• de Almeida RBS, et al. Surgical treatment applied to bilateral vocal fold paralysis in adults: Systematic review. Journal of Voice; 2023; doi:10.1016/j.jvoice.2020.11.018.
• Ekbom DC (expert opinion). Mayo Clinic. May 31, 2022.
• Rapoport SK, et al. Acute vocal cord paresis and paralysis after COVID-19 infection: A case series. Annals of Otology, Rhinology & Laryngology. 2021; doi:10.1177/00034894211047829.
• Kellerman RD, et al. Hoarseness and laryngitis. In: Conn's Current Therapy 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed April 17, 2024.
• Kurz A, et al. Selective electrical surface stimulation to support functional recovery in the early phase after unilateral acute facial nerve or vocal fold paralysis. Frontiers in Neurology. 2022; doi:10.3389/fneur.2022.869900.
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• Vocal cords open and closed

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• Exercises for Unilateral Vocal Fold Paralysis

Bridget A. Russell, PhD, CCC-SLP

January 14, 2008.

• Ask the Experts
• Voice and Resonance Disorders

What can I do to return function to my paralyzed left vocal cord? Are the exercises the same as those suggested in an ATE published on your site in 2004, "U

All Licensed Speech Language Pathologists are instructed about various vocal fold disorders in their training as graduate students. I can't confirm that every class in voice disorders delves heavily into one disorder over another, but in most cases vocal fold paralysis is covered at least minimally in most curriculums. In saying that, when the student graduates they may decide upon different employment settings and there are certain professionals and settings that have more opportunities and experiences in with working with voice disordered patients. Usually Speech Language Pathologists (SLPs) that work in clinics, hospitals or other out patient rehabilitation units have more experience working with patients with paralyzed vocal fold conditions. My suggestion is to seek out those facilities in your immediate area and locate a professional who specializes in voice and voice related disorders. In terms of exercises, my experiences have differed greatly depending on the patient and their specific presenting symptoms. Not all paralysis cases look identical, some more severe, some accompanied by muscle tension in the laryngeal musculature, some paralysis may affect both vocal folds (bilateral VFP) and some may only affect one fold (unilateral VFP). Therefore, it is important to seek an evaluation by a qualified SLP and ENT (ear nose and throat physician) before attempting any of the listed activities. In saying that, there are typical facilitating approaches that usually are attempted with VFP cases. Some of these techniques were outlined in the website you listed, "Unilateral Vocal Cord Paralysis and Dysphagia" ( www.speechpathology.com/askexpert ). Often if a specific therapy technique is not working effectively the focus of therapy and the activities change to suit the patient's needs and goals for therapy. Typically as a therapist the goal would be to improve the overall vocal quality, loudness and maintain appropriate pitch for the patient's age and gender. Usually decreased loudness is the primary concern for most VFP patients. In order to increase loudness it is imperative to improve vocal fold closure and thereby increase the pressure beneath the vocal folds (subglottal pressure). As you are aware this is the main problem, the vocal folds are not coming together at midline in order to build this pressure underneath. Typically, the initial routines are to improve this closure through push/pull and other similar activities that attempt to have the healthy cord move more toward midline and compensate for the immobile cord or to get the immobile cord moving again. There are also surgical procedures that will physically move the affected cord to midline (medialization techniques) to allow the "healthy" cord to not have to move as far over to get to midline in order to contact the immobile cord. However, this is usually discussed after therapy has not improved the condition. There are also surgical interventions that involve "increasing the size" of the affected cord by injecting a substance such as collagen, Teflon or Radinesse. This effectively makes the affected cord bigger and again eases the movement of the "healthy" cord to make midline closure. Now back to the exercises of push/pull. This exercise involves pushing or pulling up on a chair or a wall with your hands and trying to forcefully close the vocal folds while pushing/pulling up or out (depending on the activity). The theory is that when people lift objects or push objects there folds naturally close to build pressure to gain force to complete the action. The pulling or pushing usually is for about 1-2 seconds with repetitions of 8x per activity. The therapist and the patient should always be careful that excess muscle strain present in other laryngeal muscles is not occurring as this can impede the movement of the folds and create more problems and ultimate worsen voice quality. It is a delicate balance between strengthening one muscle group in the larynx and making sure tension does not elevate in the surrounding muscles impeding easy voicing. Other exercises that seem to create this balance are starting with a gentle massage of the laryngeal musculature through manual circumlaryngeal massage (Aronson Technique). This allows decreased muscle tension prior to starting voicing therapies. Also the Lee Silverman Voice Treatment Program (Developed by Lori Ramig) has been used to improve loudness in VFP cases. This approach has a series of exercises with the basic premise of talking "loud" even if your goal is normal loudness. Essentially by attempting to speak louder you are moving the vocal folds closer together thus there is the increased possibility of improved closure and thus increased loudness levels. Other exercises in this approach include flexibility drills (attempting to move from lowest to highest pitch on a glide at various frequencies on a vowel /a/). Another technique is digital manipulation of the larynx. Essentially the affected cord is physically pushed over to the other mobile cord again to reduce the distance between the immobile and mobile fold. The larynx is moved over with the hand and the hand is eventually removed over time when the patient is used to the positioning of the larynx. Other elements of successful therapies include improving overall patient awareness of respiratory support of voice, appropriate hygiene and vocal care (water intake, etc), vocal fold and upper airway anatomy. Progress in therapy should also be monitored constantly and manipulated to suit the patient's goals in therapy. Facilitating approaches to improving vocal quality should constantly be evaluated by the therapist and the patient. Bridget A. Russell is an Associate Professor at the State University of New York Fredonia and directs the Speech Production Laboratory in the Youngerman Centers for Communicative Disorders at the University. She has published in the Journal of Speech, Hearing and Language (JSHLR), Speech and Voice Review. She has presented over 70 peer reviewed presentations at national and international conferences on voice and respiratory disorders. Dr. Russell also has served as an editorial consultant for JSHLR, National Science Foundation (NSF) and DelMar Publishing Group. Dr. Russell's research interests include voice disorders in children and adults, professional voice, and respiratory disorders of speech production.

Bridget A. Russell, PhD , CCC-SLP

Dr. Bridget A. Russell received her BA, MA, and PhD from the State University of New York at Buffalo. She is an Associate Professor at the State University of New York at Fredonia and has 21 years of experience as a Speech-Language Pathologist specializing in voice disorders, respiratory training therapy, and transgender voice treatment. She has over 160 regional, state, national, and international presentations. She has published works in JSHLR, CICSD, The Communicator, SpeechPathology.com, and Voice and Speech Review and has served as an editorial consultant for JSHLR and Delmar Publishing Group. She has mentored over 60 student independent research projects culminating in 12 graduate research awards at regional and state association conventions. She is director of the Speech Production Laboratory at SUNY Fredonia which includes research collaborations with Oishei Children's Hospital in Buffalo, NY.

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Paralyzed Vocal Cord Exercises

Ken Tamplin, Professional Vocal coach

Reviewed by Editorial Team

Updated on December 18, 2023

Learn How To Sing Better Than Anyone Else

Table of Contents

Improved speech clarity.

Paralyzed vocal cords can significantly impact speech clarity, making it difficult to communicate effectively. However, incorporating specific exercises into your routine can help improve speech clarity. One effective exercise is straw phonation. This involves making sounds while exhaling through a straw, which helps to strengthen the vocal cords and improve their coordination. Another beneficial exercise is vocal cord adduction exercises, which involve practicing making sounds by bringing the vocal cords together. These exercises can help to enhance the strength and coordination of the vocal cords, leading to improved speech clarity over time.

Straw Phonation Exercise

Straw phonation is a widely used exercise to improve speech clarity in individuals with paralyzed vocal cords. To perform this exercise, you will need a straw. Begin by taking a deep breath and exhaling gently through the straw while making a continuous “humming” sound. This exercise helps to provide resistance to the airflow, promoting better closure and coordination of the vocal cords.

Vocal Cord Adduction Exercises

Vocal cord adduction exercises involve practicing making sounds that require bringing the vocal cords together, such as saying “ee” or “oo.” These exercises aim to train the vocal cords to come together effectively, which is essential for improved speech clarity.

Enhanced Swallowing Function

Paralyzed vocal cords can also impact swallowing function, leading to difficulties in eating and drinking. However, specific exercises can help enhance swallowing function and reduce the risk of aspiration. One effective exercise is the Mendelsohn maneuver, which involves swallowing and holding the throat muscles in a raised position for a few seconds. This exercise helps to strengthen the muscles involved in swallowing, leading to improved swallowing function over time.

Mendelsohn Maneuver

To perform the Mendelsohn maneuver, start by swallowing while focusing on the upward movement of your throat muscles. Hold your throat muscles in the raised position for a few seconds before relaxing. Practicing this maneuver regularly can help strengthen the muscles involved in swallowing, leading to enhanced swallowing function.

Psychological Benefits of Vocal Cord Exercise

Engaging in vocal cord exercises not only offers physical benefits but also provides psychological advantages. Individuals with paralyzed vocal cords often experience frustration and a sense of loss due to communication difficulties. By actively participating in vocal cord exercises, individuals can regain a sense of control over their voice and communication abilities. Additionally, as speech clarity and swallowing function improve, individuals may experience a boost in confidence and overall well-being.

Practical Tips and Advice

Setting realistic goals for vocal cord rehabilitation.

When embarking on vocal cord rehabilitation, it is essential to set realistic goals to track progress effectively. Speak with a speech-language pathologist to gain insights into what to expect and how to set achievable milestones. Setting realistic goals can help maintain motivation and provide a clear path toward vocal cord rehabilitation.

Tracking Progress and Adapting Exercise Regimen

Tracking progress is crucial in vocal cord rehabilitation. Keep a journal to document improvements in speech clarity and swallowing function. Additionally, be open to adapting your exercise regimen based on your progress. Consult with your speech-language pathologist to make necessary adjustments to your exercises and techniques as you progress through rehabilitation.

Integrating Vocal Therapy Techniques into Daily Activities

To maximize the benefits of vocal cord exercises, consider integrating vocal therapy techniques into your daily activities. Practice speaking exercises during conversations with friends and family, and incorporate swallowing exercises with meals. By integrating these exercises into daily activities, you can make consistent progress in vocal cord rehabilitation.

In conclusion, engaging in paralyzed vocal cord exercises can significantly improve speech clarity, enhance swallowing function, and provide psychological benefits. Incorporating exercises such as straw phonation, vocal cord adduction exercises, and the Mendelsohn maneuver can lead to positive outcomes in vocal cord rehabilitation. By setting realistic goals, tracking progress, and integrating vocal therapy techniques into daily activities, individuals can effectively work towards improving their vocal cord function and overall quality of life.

1. How often should I perform vocal cord exercises?

It is recommended to perform vocal cord exercises as advised by your speech-language pathologist. Typically, exercises may be performed daily or as per a specific schedule tailored to your rehabilitation plan.

2. Can vocal cord exercises completely restore vocal cord function?

While vocal cord exercises can lead to significant improvements in vocal cord function, the extent of restoration varies among individuals. Consistency and adherence to the recommended exercises play a crucial role in achieving positive outcomes.

3. Are there any dietary restrictions during vocal cord rehabilitation?

Your speech-language pathologist may provide specific dietary recommendations based on your swallowing function. It’s essential to follow any dietary guidelines provided to support your vocal cord rehabilitation.

4. Can vocal cord exercises help with breath control during speech?

Yes, vocal cord exercises can contribute to improved breath control during speech by strengthening the muscles involved in vocalization. As speech clarity improves, individuals may also notice enhanced breath control.

5. How long does it take to see improvements from vocal cord exercises?

The timeline for seeing improvements from vocal cord exercises varies for each individual. Some may notice improvements within a few weeks, while others may require a longer duration. Consistent practice and adherence to the exercise regimen can contribute to positive outcomes over time.

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Vocal Fold Paresis

Related articles.

• Behavioral Treatment
• In-Office Vocal Fold Injection
• Laryngeal Framework Surgery

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• Laryngoscopic and Stroboscopic Signs in the Diagnosis of Vocal Fold Paresis
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What is vocal fold paresis?

"Paresis" means partial paralysis. Vocal fold paresis refers to a vocal fold with motion impaired (but not absent – that condition is called vocal fold paralysis ) because the nerve in the muscles of the vocal fold is damaged. Most commonly, this happens as a result of a routine viral infection like a cold, although any surgery that can cause vocal fold paralysis can also cause paresis. Paresis is generally not caused by tumors pressing on the nerve, although there may be very rare exceptions.

Problems result because even though the vocal fold can move, it cannot meet the other vocal fold to close well during voicing. Or, it can meet the other vocal fold, but only with unusual or extreme effort.

What are the symptoms of vocal fold paresis?

Because the vocal folds cannot close well during voicing, the voice may be soft, hoarse or breathy. As the closure is not severely compromised, changes can be very subtle or apparent only in challenging acoustic situations, such as when speaking over background noise, teaching class, or giving a presentation. An individual with paresis may be aware of an unusual amount of effort, or a sense of breathlessness, during prolonged or loud talking. Sometimes, muscles not usually involved in voicing will be engaged to try to bring the vocal folds together, which can cause pain when speaking. Occasionally, there may be no evident voice change at all, and pain and/or breathlessness when speaking may be the only signs of the problem. Paresis is usually relatively prompt in onset, so individuals are able to recall a fairly precise time that their voice changed.

What does vocal fold paresis look like?

Vocal fold paresis is one of the most challenging diagnoses is laryngology because the changes from normality are often slight. In general, a physician looks for limitations in motion of one vocal fold, and signs of impaired closure. There may be thinning of the affected vocal fold or atrophy of muscle mass. In addition, the other vocal fold may show signs of unusual muscular effort during voicing.

At left, the vocal folds are shown during quiet breathing. The arrow shows thinning of the left vocal fold, indicative of paresis on that side. At right, the vocal folds are shown during voicing. The arrow indicates the bulge of the ventricular fold on the good side, suggesting unusual muscular effort being used to bring the folds together. Note that the gap between the vocal folds is not obvious.

The greatest challenge in the diagnosis of vocal fold paresis may be distinguishing it from insignificant asymmetries of motion of the two vocal folds. There is no biological requirement for the vocal folds to move in perfect coordination, and laryngeal asymmetries are routine findings in patients evaluated for unrelated complaints. If one is so inclined, one could find signs suggesting paresis in virtually every adult or, at the other extreme, one could dismiss every asymmetry as meaningless. Clinical judgment is necessary to separate paresis from innocent motion abnormalities – signs should be consistent with one another and match the patient’s symptoms as well as the history of the complaint.

In another case, there is no obvious asymmetry between the vocal folds during quiet breathing, at left. During voicing however, the extreme effort exerted by the unaffected right vocal fold is apparent (arrow).

How is vocal fold paresis treated?

Some cases of vocal fold paresis recover by themselves over several weeks or months. Neither resting the voice nor exercising the vocal folds has been shown to have any effect on recovery. Similarly, no medicine has been proven to help.

Some physicians have found a test known as electromyography (EMG) to be helpful in diagnosing paresis. EMG is performed by putting needles into the muscles of the larynx through the skin of the neck for a few minutes to record electrical activity. However, there is debate about whether EMG is sensitive enough to correctly identify mild paresis, and/or if every mild abnormality identified by EMG signifies paresis.

Because both voice problems and the gap between the vocal folds resulting from paresis are relatively mild, voice therapy is a reasonable initial treatment. By itself, it may be sufficient to overcome the limitations of paresis, and may help minimize any muscular discomfort. Should the paresis not recover and should voice therapy be insufficient to address the resulting problems, it is possible to address voice quality and other symptoms by repositioning the weak vocal fold closer to its partner. This is known as medialization. In brief, this can be accomplished by injecting the vocal fold with one of a number of available substances ( injection augmentation ), or by placing a block of artificial material into the larynx through an operation on the outside of the neck (medialization laryngoplasty). Each technique has its own advantages, and making an intelligent choice among available treatments depends upon detailed discussion with your physician.

Sean Parker Institute for the Voice Weill Cornell Medical College 240 E 59th Street New York, NY 10022 Map it

Vocal Cord Dysfunction (VCD)

Paradoxical vocal fold movement (pvfm).

Our voice specialists use the latest diagnostic tests along with their years of experience to determine whether you have vocal cord dysfunction (VCD), also known as paradoxical vocal fold movement (PVFM). Specially trained speech-language pathologists help you understand the common triggers for VCD episodes and teach you breathing exercises to help relax the throat and ease your symptoms.

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About Vocal Cord Dysfunction

VCD, a type of irritable larynx syndrome , is an upper airway disorder related to irritation of the voice box. Normal breathing requires the vocal cords to remain open so air can pass in and out of the lungs. During a VCD episode, the vocal cords start to close involuntarily during inhalation. Since your airway is narrowed, you may feel like you can’t inhale. Sometimes, sounds may come from your throat during an episode. VCD is frequently misunderstood, misdiagnosed, and mistaken for asthma or a severe allergic reaction because of similar symptoms.

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Speech Therapy for Vocal Cord Dysfunction

Speech therapy is the primary treatment for VCD. Specially trained speech-language pathologists teach you exercises designed to relieve episodes of VCD. You will learn relaxed-throat breathing and lower-abdominal breathing strategies to manage episodes of breathing difficulty. These simple techniques keep the upper airway and voice box relaxed and open for easier breathing. Your speech-language pathologist will also work with you to understand your VCD triggers and control your response to these triggers. If you are an athlete with VCD, we'll coordinate with your coaches as appropriate to provide education about the condition and promote breathing strategies for you in your sport(s).

• Voice Therapy

For many, VCD can cause throat strain during and after episodes. If this occurs, the voice itself can become strained or hoarse. A speech-language pathologist will guide you through vocal exercises to improve breathing, reduce throat strain, and find your optimal pitch and volume for strong, healthy speaking. Improving your voice will not only help you speak more easily and clearly, but it can reduce your throat irritation and shortness of breath.

Our team will take a detailed history of your breathing symptoms to note the patterns that suggest VCD and identify any triggers for these episodes. Your laryngologist -- an ear, nose, and throat (ENT) doctor with advanced training in voice and throat disorders -- will also evaluate whether any medical conditions, surgeries, or recent illnesses could have caused changes in your voice or breathing. We will perform a head and neck examination and a visual examination of your voice box.

Videolaryngostroboscopy

This detailed visual examination of your voice box helps us evaluate how your vocal cords open, close, and vibrate while you breathe and speak or sing. A tiny camera attached to a small tube called an endoscope is inserted through your nose and into your throat, which allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow-motion video images of your vocal cords. The exam takes about two minutes, and your nose can be sprayed with topical anesthetic for comfort.

Your team will look for lesions, stiffness, paralysis, irregular movements, throat strain, or incomplete closure of the vocal cords. If VCD is suspected, your team will evaluate the movement of your vocal cords during breathing. Actual episodes of VCD are rarely seen on these exams, but your voice box will be evaluated to make sure that all the structures are normal. After the exam, your team will review the images with you to discuss your diagnosis and treatment plan. Videolaryngostroboscopy is essential to reaching an accurate diagnosis and determining the best treatment for VCD and other voice box problems.

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 10 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

Why Choose Duke

Team of Experts At Duke, one of the few comprehensive voice centers in the Southeast, your care team will include laryngologists and speech-language pathologists specially trained to evaluate and treat patients with voice problems and laryngeal disorders. Our team has years of experience treating VCD.

Team Care Approach If you have other medical conditions that may contribute to your voice issues -- such as allergies, asthma, or acid reflux -- we will work with your other providers throughout Duke Health to ensure you receive the best care from an integrated team.

Care for Athletes If you are an athlete with VCD, we'll coordinate with your coach as appropriate to provide education about your disorder and promote breathing strategies for you in your sport.

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What to Know About Vocal Cord Paralysis

Your vocal cords play a more significant role in your body than simply helping you talk and sing. They protect your airway, prevent food, drink, and saliva from getting into your windpipe, and help keep you from choking. When your nerve impulses to your larynx, or voice box, are disturbed, you can have  vocal cord paralysis. This condition makes it hard for you to speak or even breathe. 

Mild cases of vocal cord paralysis can improve with voice therapy and vocal rest. Depending on the damage to your vocal cords, you may need surgery. 

What Is the Cause of Vocal Cord Paralysis?

Your vocal cords are two elastic bands of muscle tissue in your voice box. Your vocal cords are located right above your windpipe or trachea. Vocal cords work by moving apart when you breathe and closing tightly when you swallow. The air from your lungs makes your vocal cords vibrate, and this helps you speak. 

Two types of paralysis can affect your vocal cords. Unilateral paralysis -- paralysis on one vocal cord -- is the most common. Bilateral paralysis -- which occurs on both cords -- is less common but can be more life-threatening. 

Unilateral vocal cord paralysis can be caused by: 

• Brain tumors 
• Tumors at the base of your skull 
• Neck trauma
• Thyroid gland tumors 
• Neurotoxin poisoning like lead, arsenic, or mercury 
• Cervical spine injury 
• Lyme disease
• Viral illness

Bilateral vocal cord paralysis can be caused by: 

• Thyroid and  cervical surger y 
• Tracheal intubation 
• Neuromuscular diseases
• Neurodegenerative diseases

Anyone can have vocal cord paralysis. However, women are more likely to have this condition than men. 

If you have the following neurological conditions, you are likelier to get paralyzed vocal cords: 

• Multiple sclerosis 
• Parkinson’s disease  
• You have previously had a stroke

What Are the Symptoms of Vocal Cord Paralysis?

You might notice slight changes in your voice that may seem to be caused by allergies or a cold. The severity of your symptoms will also depend on how your voice box adapts to the degree of paralysis. 

Vocal cord paralysis symptoms can range from mild to severe. They include: 

• Hoarseness in your voice 
• Breathy voice change s  
• Shortness of breath 
• Noisy breathing 
• Difficulty swallowing 
• Choking or coughing when you eat

Other symptoms include: 

• Frequent breaths while speaking
• Inability to talk loudly
• Loss of gag reflex
• Frequent throat clearing

What Is the Treatment for Vocal Cord Paralysis?

After surgery, you’ll need a strong base of support to help you recover and avoid talking as much as possible. Keeping the damage minimal can help to speed up your recovery. 

Your treatment for vocal cord paralysis will depend on the cause and severity of your symptoms. Treatments may include:

Voice therapy.  Voice therapy helps strengthen your vocal cords. Your speech-language pathologist may have you do exercises that help you control your breathing while you talk or help reduce tension in your other muscles around your paralyzed vocal cords.

Surgery.  You will need surgery if your vocal cords don’t fully recover by themselves. Your options for surgery include: 

• Bulk injection, which fills your vocal cords with collagen or another filler substance 
• Structural implants, also known as thyroplasty or medialization laryngoplasty, that reposition your vocal fold  
• Vocal cord repositioning, in which your tissue from the outside of your voice box moves inward 
• Replacement of the damaged nerve
• A tracheotomy, which is for bilateral paralyzation

The doctor will also help you learn how to take care of your breathing tube if you’ve had a tracheotomy. 

After surgery, a  speech-language pathologist will help you learn how to use your voice. You’ll need to avoid talking, so a strong support system is necessary while you recover. 

Emerging treatments. Some research has shown that electrical stimulation can help open and close your vocal cords. This stimulation may come from a nerve in another part of your body or a device like a pacemaker. 

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Vocal Fold Paralysis

On this page:

What is vocal fold paralysis?

What causes vocal fold paralysis, what are the symptoms, how is vocal fold paralysis diagnosed, how is vocal fold paralysis treated, what research is being done on vocal fold paralysis, where can i get help, where can i get additional information.

Structures involved in speech and voice production

Vocal fold paralysis (also known as vocal cord paralysis) is a voice disorder that occurs when one or both of the vocal folds don't open or close properly. Single vocal fold paralysis is a common disorder. Paralysis of both vocal folds is rare and can be life threatening.

The vocal folds are two elastic bands of muscle tissue located in the larynx (voice box) directly above the trachea (windpipe) (see figure). When you breathe, your vocal folds remain apart and when you swallow, they are tightly closed. When you use your voice, however, air from the lungs causes your vocal folds to vibrate between open and closed positions.

If you have vocal fold paralysis, the paralyzed fold or folds may remain open, leaving the air passages and lungs unprotected. You could have difficulty swallowing or food or liquids could accidentally enter the trachea and lungs, causing serious health problems.

Vocal fold paralysis may be caused by injury to the head, neck, or chest; lung or thyroid cancer; tumors of the skull base, neck, or chest; or infection (for example, Lyme disease). People with certain neurologic conditions such as multiple sclerosis or Parkinson's disease, or who have sustained a stroke, may experience vocal fold paralysis. In many cases, however, the cause is unknown.

Symptoms of vocal fold paralysis include changes in the voice, such as hoarseness or a breathy voice; difficulties with breathing, such as shortness of breath or noisy breathing; and swallowing problems, such as choking or coughing when you eat because food is accidentally entering the windpipe instead of the esophagus (the muscular tube that connects the throat to the stomach). Changes in voice quality, such as loss of volume or pitch, also may occur. Damage to both vocal folds, although rare, usually causes serious problems with breathing.

Vocal fold paralysis is usually diagnosed by an otolaryngologist—a doctor who specializes in ear, nose, and throat disorders. He or she will ask you about your symptoms and when the problems began in order to help determine their cause. The otolaryngologist will also listen to your voice to identify breathiness or hoarseness. Using an endoscope—a tube with a light at the end—your doctor will look directly into the throat at the vocal folds. Some doctors also use a procedure called laryngeal electromyography, which measures the electrical impulses of the nerves in the larynx, to better understand the areas of paralysis.

The most common treatments for vocal fold paralysis are voice therapy and surgery. Some people's voices will naturally recover sometime during the first year after diagnosis, which is why doctors often delay surgery for at least a year. During this time, your doctor will likely refer you to a speech-language pathologist for voice therapy, which may involve exercises to strengthen the vocal folds or improve breath control while speaking. You might also learn how to use your voice differently, for example, by speaking more slowly or opening your mouth wider when you speak. Several surgical procedures are available, depending on whether one or both of your vocal folds are paralyzed. The most common procedures change the position of the vocal fold. These may involve inserting a structural implant or stitches to reposition the laryngeal cartilage and bring the vocal folds closer together. These procedures usually result in a stronger voice. Surgery is followed by additional voice therapy to help fine-tune the voice.

When both vocal folds are paralyzed, a tracheotomy may be required to help breathing. In a tracheotomy, an incision is made in the front of the neck and a breathing tube is inserted through an opening, called a stoma, into the trachea. Rather than occurring through the nose and mouth, breathing now happens through the tube. Following surgery, therapy with a speech-language pathologist helps you learn how to use the voice and how to properly care for the breathing tube.

The National Institute on Deafness and Other Communication Disorders (NIDCD) supports research studies that explore the causes of vocal fold paralysis as well as better ways to treat the disorder. One surgical procedure, called medialization laryngoplasty, inserts a structural implant into the larynx to return voice quality. However, close to a quarter of the people who receive this treatment must return for repositioning surgery to fine-tune the placement of the implant. An NIDCD-supported researcher currently is developing a pre-operative planning system that uses 3-D computer modeling to determine the best location for, and configuration of, the implant. The surgery also uses an image-guided system that allows the surgeon to visualize the precise location of the vocal fold to ensure exact placement of the implant. Researchers hope this new system will reduce the need for repeated surgeries and lower the cost and risk of surgical complications from the procedure.

The NIDCD also has been supporting a decades-long project to develop an electrical stimulation technology to help people avoid having a tracheotomy when both vocal folds are paralyzed. The device, which currently is being tested in animals and people, uses an implanted pacemaker to stimulate laryngeal nerves. This returns mobility to the vocal folds so that they can open to allow breathing and close to allow speaking and swallowing.

If you notice any unexplained voice changes or discomfort, you should consult an otolaryngologist or a speech-language pathologist for evaluation and possible treatment.

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language. Please see the list of organizations at www.nidcd.nih.gov/directory .

Use the following keywords to help you search for organizations that can answer questions and provide printed or electronic information on vocal fold paralysis:

• Laryngology
• Speech-language pathologist

For more information, contact us at:

NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 Toll-free voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Email: [email protected]

Publication No. 11-4306 Updated October 2011

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About Vocal Cord Paralysis

Vocal Cord Paralysis (VCP) is impaired movement of the vocal cords caused by an injury to the vagus or recurrent laryngeal nerves that are critical to normal speech production.

There are generally two types of VCP:

• Vocal Cord Paralysis: A complete loss of nerve input to the vocal folds. The vocal cord is not moving at all.
• Vocal Fold Paresis:  A partial loss of input to the nerve of the vocal fold. The vocal fold is moving but with reduced function.

Symptoms of VCP

Symptoms associated with unilateral recurrent laryngeal nerve damage • Breathy voice quality • Decreased vocal fold stamina with vocal fatigue • Change in power of the voice with reduced projection and loudness • Throat pain with speaking • Choking • Shortness of breath with speaking • Choking or aspiration on swallowing of water or solids Symptoms associated with superior laryngeal nerve damage • Chronic cough or choking • Swallowing difficulties • Loss of voice especially in the high notes • Limited ability for projection of voice Symptoms associated with bilateral recurrent laryngeal nerve damage • Weak voice • Noisy breathing with any exertion • Shortness of breath • Nighttime noisy breathing • Stridor • Swallow dysfunction

Who gets VCP?

Any adult or child may be at risk for sudden onset of signs and symptoms that may be attributed to vocal cord paralysis. The onset can be attributed to any of the following: • The onset of breathy voice is related to a recent viral illness. Once the viral illness is improved, the voice and swallow dysfunction does not improve. This then prompts the patient to seek healthcare. • Patients who undergo cranial, head and neck, thyroid, thoracic, cardiac and esophageal surgery, the nerve to the larynx is at risk because of the proximity of the nerve near where the surgeon is working. • Anyone who has undergone radiation therapy, intervention by angiography, or neurotoxic drug administration. • Some patients, especially elderly patients, with risk factors for cancer of the lungs, esophagus, thorax, or thyroid are at risk for developing vocal cord paralysis. • Vocal cord paralysis may be the initial presenting sign and symptom in patients that are eventually identified to have a growth or tumor along the course of the vagus nerve.

Causes of VCP

If you have been diagnosed with vocal cord paralysis, it is important that a search for a cause is made. The first fork in the diagnosis is whether the immobility of the vocal cords is a result of a neurological dysfunction or due to a mechanical issue along the nerve. Once this distinction is made, the appropriate testing for the underlying cause can begin and optimal treatment can be established. The main categories for causes of vocal cord paralysis or vocal fold paresis are Idiopathic, Iatrogenic, tumor or neoplastic, or due to disease process. • Idiopathic refers to the presence of a virus that caused inflammation of the nerve. Many viral infections have been associated with vocal fold paresis. These include herpes simplex virus, cytomegalovirus, coxsackie virus, and simple upper respiratory infections. Bacterial infections including Lyme disease and syphilis have also been reported to cause vocal fold paralysis and paresis. • Latrogenic refers to symptoms brought on unintentionally by something that a doctor does. Causes may be due to surgery of the skull base, carotid artery, neck, thyroid, esophagus, or thorax. Anything that results in manipulation of the nerve can cause injury to the long vagus nerve that arises from the skull base, goes into the chest and then comes back into the larynx. Some of the common surgical related traumas include: thyroidectomy, spine surgery, skull base surgery, thoracic surgery for aneurysm repair, and carotid endarterectomy. • Neoplastic conditions are tumors or growths along the course of the nerve or within the larynx. A search for neoplastic causes affecting the vagus or recurrent laryngeal nerve will often prompt a clinician to order radiographic imaging of the neck and chest. Some of the neoplastic conditions that may cause vocal cord paralysis include lung cancer, mediastinal tumors, thyroid cancers, and tumors of the neck and skull base. • Occasionally, nerve injury may be due to disease that affects the laryngeal nerve. These are diseases that can cause either one or multiple nerves to the larynx to become affected, resulting in nerve dysfunction.

Diagnosing VCP

The diagnosis of vocal cord paralysis, paresis, or vocal fold motion impairment is usually made in the otolaryngologist office. The diagnosis is made after a thorough history and physical examination. Diagnosis of vocal fold movement abnormality — When there is abnormal vocal fold movement found during voicing, coughing and breathing. This is called vocal cord paresis. Diagnosis of vocal fold immobility—When there is no movement of the vocal fold. This is called vocal cord paralysis. Determining whether the nerve is permanently or temporarily injured is determined by more in-depth electrodiagnostic testing is required. — Videostroboscopy and Voice assessment by a speech language pathologist may be used. — Stroboscopy allows for more detailed view of the vibratory characteristics of the vocal fold and assess the severity of function related to vocal cord closure. — Laryngeal electromyography assesses the electrical activities of the intrinsic muscles of the larynx and allows the clinician to differentiate what muscles and nerves are involved. If the cause of the VCP is not readily determined during the exam, the person will be asked to undergo additional testing. It is important to determine the root cause of the VCP because one of the cause is a mass or tumor on the nerve pathway. A CT scan with contrast of the neck and chest from skull base to the aortic arch is sufficient to evaluate for most of the malignancies that could impair nerve function. If the clinical findings on physical examination suggest higher vagal nerve involvement, an MRI (magnetic resonance imaging) of the brain and skull base may also be considered. If there is swallow dysfunction and aspiration, a barium swallow may also be recommended.

Treatment of VCP

Treatments are dictated by the root cause of the VCP. That’s why early identification of the cause is critical. 1) If loss of vocal motion is a symptom of a disease, the disease treatment may alleviate the VCP. 2) In people who have had surgery, identification of nerve injury or mechanical injury to the larynx may be reversed by appropriate early surgical intervention. Damaged nerves to the larynx have the potential for complete or partial recovery. 3) In people who have a tumor or mass, treatment of the underlying cause may have an impact on vocal issues. 4) In people with a virus, treatment of the virus can impact the resulting vocal issue. When there is only inflammation of the nerve or where the nerve was only stretched, the nerve can be expected to recover without major disability.

Other Possible Interventions for VCP

Voice therapy and referral for speech-language pathologist can be an important alternative to surgical intervention in patients with symptomatic vocal cord paralysis. They can help in education of the patient’s regarding better laryngeal function. They can use therapeutic intervention approaches to improve the voice as well as swallow dysfunction. In people with mild breathy voice quality therapy can include compensatory strategies to vocal exercises to improve glottic function. The speech-language pathologist is also a integral part of the voice rehabilitation team after surgical intervention for vocal cord paralysis The body is miraculous and is always attempting to heal itself. As a result, a do nothing approach may be advocated. Wait and see is a conservative way to treat vocal cord paralysis or paresis and is for people with minimal symptoms or for those who do not wish to pursue intervention. Office injection laryngoplasty is sometimes used to push the vocal cord that is paralyzed or thinned out into a better position Operative injection laryngoplasty is appropriate when the vocal cord cannot be easily accessed using an office-based approach or if the material that is to be injected is very viscous or large volumes are anticipated. Medialization laryngoplasty pushes the vocal fold into a better position by inserting an implant lateral to the vocal cord. Reinnervation is a procedure where the nerve that is paralyzed is connected to another nerve that is active and thereby results in reinnervation. The choice of whether to proceed with reinnervation is dependent on the prognosis for nerve return, the person’s age, and functional deficit.

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Explore Vocal Cord Paralysis

The Voice Center at UT Southwestern Medical Center offers exceptional expertise in diagnosing and treating vocal cord paralysis and other voice disorders. Our multidisciplinary team includes fellowship-trained laryngologists and speech-language pathologists who are committed to improving voice quality.

Advanced Care for Vocal Cord Paralysis

The vocal cords are located in the larynx (voice box) and vibrate to produce sound for speaking and singing. Vocal cord paralysis occurs when one or both vocal cords lose the ability to move, which can affect the voice, breathing, and swallowing.

Our multidisciplinary team combines the expertise of fellowship-trained laryngologists (ear, nose, and throat specialists with specialized training in disorders of the larynx), speech-language pathologists with training specifically in voice care, and other care professionals with expertise in voice and throat conditions. Our team members are widely recognized as experts in the accurate diagnosis and effective treatment of vocal cord paralysis. Through our research, we have made important contributions to the standard of care and are improving the lives of patients, here and across the country.

Causes of Vocal Cord Paralysis

Vocal cord paralysis develops when nerves that control the vocal cord muscles become damaged or inflamed. Often, the underlying causes of vocal cord paralysis are not known. Some known causes include:

• Viral infections
• Injuries to the neck or chest
• Injury to the vocal cord nerve during surgery in nearby areas
• Neurological disorders such as multiple sclerosis
• Noncancerous tumors
• Vocal cord cancer
• Cancer in the chest or neck

Symptoms of Vocal Cord Paralysis

Symptoms include:

• Breathy or weak-sounding voice
• Changes in vocal pitch (high or low)
• Choking or coughing while swallowing
• Difficulty breathing
• Difficulty swallowing
• Inability to speak loudly
• Noisy breathing

Diagnosis of Vocal Cord Paralysis

Our voice care team at UT Southwestern includes fellowship-trained laryngologists and speech-language pathologists who conduct a thorough evaluation, which can include:

• Physical exam, with an inspection of the vocal cords
• Review of personal medical history
• Discussion of symptoms

Other tests we typically use include:

• Laryngoscopy:  An exam using a narrow tube, either flexible or rigid, with a light and camera inserted through the nose
• Videostroboscopy: An exam using a telescope-like camera with a flashing light that provides a magnified, slow-motion view of the vocal cords as they vibrate
• Laryngeal electromyography (EMG):  Small needles inserted through the skin into voice box muscles to measure their electric currents
• Sound (acoustic) analysis: Computer analysis that identifies abnormalities in the sounds produced by the vocal cords

Treatment for Vocal Cord Paralysis

At UT Southwestern, we usually begin treatment for vocal cord paralysis with nonsurgical therapies, such as:

• Speech therapy , with exercises to strengthen vocal cords, improve breath control during speech, and protect the airway when swallowing
• In-office filler injections to enlarge a paralyzed vocal cord so that it comes in contact with the functioning cord to produce sound, for improved voice quality and a more efficient cough

We typically recommend surgical procedures for patients whose symptoms don’t improve with conservative treatments. Our surgeons offer:

• Injection augmentation to the paralyzed vocal cord using fat typically taken from the belly
• Thyroplasty: Surgery to place an implant in the paralyzed vocal cord and position it closer to the functioning vocal cord
• Arytenoid adduction: Surgery to position the paralyzed vocal cord joint closer to the functioning vocal cord to improve speech, breathing, and swallowing
• Laryngeal reinnervation surgery: Procedure to connect a damaged nerve to a functioning nerve to improve nerve signals that control vocal cord muscles

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Section 2 - Exercises to achieve full closure of the vocal cords

There are many reasons why the vocal cords may not come together in the way they need to for normal voice production. In the links on the right, there are exercises to help achieve this closure. Please follow directions from your Speech and Language Therapist to the exercises which are best for you. 

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6 Simple Daily Vocal Exercises When Suffering Vocal Disorders

Introduction.

Regular vocal exercises are important to our vocal health In order to maintain your vocal quality, you must practice correct voice production. Generating your voice in a proper way may minimize air intake during speaking or singing.

Vocal disorders over-stressing of your vocal folds, excessive rubbing of the cords against each other, and producing too loud and sharp voices.

By daily practicing correct voice production, you can minimize the rubbing of your vocal cords against each other. This shall keep them intact and make them more flexible.

In case of hoarseness, or chronic vocal disorders or discomforts, a 3 to 5 minutes of exercise, twice a day, is an essential part of the treatment. Daily exercises will eventually make your vocal folds move more moderately. This can help treating existing disorders, as well as preventing new ones.

Do not perform any vocal exercises in cases of sore throat.

In cases of vocal cords hemorrhages, or when you recover from a vocal cords nodule / polyp / cyst removal surgery, keep completely silent, if your doctor recommends it.

In case of ailments, edema, redness, or swelling of the cords, you better use TMRG Voice Powder or TMRG Classic Spray, to prevent overstraining of the cords. Otherwise, the exercises will just increase the cords rubbing against each other.

Preferably, one should regularly consult a vocal teacher or a speech therapist, in order to receive all necessary information and instructions for dealing with common disorders.

But, if such a consultation is impossible for you, you should perform these exercise, to help your vocal system. Naturally, our customers prefer using TMRG products, but daily exercise would enhance the products’ effects.

Theoretical background:

Your voice may sound either “thin” or “full”.

A thin voice is generated when only the outer edges of your vocal folds contact each other. By contrast, a “full” voice is generated when your vocal folds are tightly pressed against each other, only allowing a minimum airflow. In the latter case, your voice strongly resonates from your lower resonance cavities (rib cage, larynx, and oral cavities).

Whenever you speak loudly, you use a “full” voice”

Whenever you sing high notes lightly, with airy sound, you use a “thin” voice. (One can, of course, sing high pitches with a ‘full”, loud and thick voice.)

Words consist of consonants, produced by stopping the airflow, and vowels, when air is forced in the voice box. By performing easy airflow exercises, you could achieve an even and smooth airflow through your voice box as well as smooth movement from consonants to vowels. As a result, your vocal organs will grow smoother, upgrading your vocal performance.

6 Key Exercises

Nasal air pressure vocal exercises..

When you channel the airflow towards your nose, either when speaking or singing, you enhance your vocal intensity while minimizing the stress of your larynx. To find this resonance spot, take an “n-g” sound.

When directing the sound towards your nose, carefully make sure to leave the passage slightly open. This way, you can prevent the tone from getting too nasal (unless you want it to sound this way).

Directing the air pressure towards your nose also makes it easier for you to move to higher pitchers.

In such exercises, it is important to feel the rib-cage resonance. When singing, you should also stress your frontal cavities and sinuses resonances.

The “sh” sound vocal exercise:

• Empty your lungs completely, breathing through your mouth and making a “sh” sound for eight seconds. Bring the tip of your tongue close to your front teeth, and draw your lips forward, to distance them from your gums.
• Breathe in through your nose, for 4 seconds, with your mouth closed.
• Hold your breath for eight seconds.
• Repeat the process, continuously, for about 10 times. When you first practice it, repeat it 5 times, and gradually increase the repetitions.

During this exercise, you should feel a slight pressure from the abdomen, and expose your lower teeth.

It serves to regulate airflow and respiratory and vocal organs coordination, for improving your vocal control and thickening a thin and weak voice. Making a “sh” sound repetitively, strengthens the lower abdominal vocal support muscles, and helps directing the airflow forward.

The “brrr” Exercise

Make a “brr” or a “prr” sound, rolling your lips, in rising and descending tones, within a range which feels comfortable. During the exercise, it is better to place 2 fingers on your cheeks, near your dimples, without moving your chin. You can put your hand on your chin occasionally, to mark the spot.

Intensify the sound gradually, and also fluctuate it, by shaking your diaphragm. Project the sound outwards. Perform this exercise between 2 and 3 minutes.

This exercise is meant to relax your lips and many other vocal organs. It also significantly improves the coordination between the voice box and vocal support muscles, namely the diaphragm, intercostal muscles, and muscles of the torso(back). It helps preventing lazy lips and intensifies the oral and vocal muscles sensation.

Straw Exercises:

1. Make rising and descending tones, at a moderate intensity, with a drinking straw in your mouth.

This should help you control airflow and minimize air intake.

2. Blow through the straw into half a cupful of water, making rising and descending tones, so that you see bubbles. Try to make as small bubbles as possible. This should help you minimize air intake .

Then, blow at various range, while shaking your abdomen and diaphragm. This should help you practice diaphragm and vocal organs coordination, as well as diaphragm vibration.

3. Speak through a straw: this should help your muscle memory of the ways to speak properly and minimize air intake.

During all three exercise, you should increase your breathing range, in order to practice diaphragm support and the use of counter-force. This helps making your vocal cords and muscles healthier and stronger.

Nasal resonance exercise: making an “n” sound.

• Close your nostrils, but make sure to leave a small air passage, so that the sound does not get too nasal. Make sure to direct the airflow towards your nose. You should feel a buzz in your nose.
• “nay” (“n” should sound nasal. When making it, the front of your tongue should close the air passage to your mouth, to make the air flow directly to your nose. Do not press your tongue too tightly.

“twang” (try imitate a duck call, to intensify it).

Perform the exercise for 2 to 3 minutes. You can repeat this sounds at rising and descending tones, or as a singing exercise, moving either from lower to higher tones, or the other way around. The sound should be concentrated, metal, non-airy and nasal.

This exercise is essential for learning to make “mask sound”, or frontal resonance sound. It should increase your resistance to vocal stress and prevent involuntary

Contractions.

Vocal cords closing exercise:

Consonants invigorate the sound and enhancing its momentum.

Warning: do not practice it in case of hoarseness or vocal cords ailments.

Make the following sounds:

“d-t-d-t”, and so on.

“b-p-b-p”, and so on.

K-g (like “game”)-k-g” (this should make your rear palate and lower tongue more flexible).

Pronounce these consonants by blocking the airflow, and then letting it burst. Make the pronunciation as short as possible.

You may also increase the range, to make the exercise more challenging.

To conclude

Gentle vocal exercises for singers can make your voice glow more freely when you speak. It also works the other way around: you can sing more powerfully if you practice fluent and articulate speech, using many vocal muscles, especially practicing smooth movements between consonants and vowels, and strengthen your lazy vocal muscles.

This should make you feel your vocal muscles are more resistant to vocal stress, and prevent vocal muscles involuntary contractions.

In cases of vocal stress and other vocal disorders, a combination of TMRG solutions and exercising should shorten the recovery of your voice. It also helps regular vocal maintenance.

TMRG voice specialist

Damaged Vocal Cord Exercises

Composed of muscle tissue, vocal cords are the two small elastic bands within the larynx. When air is exhaled through the trachea, it passes through the closed vocal cords, causing them to vibrate and produce noise.

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When you are not speaking, the vocal cords remain open and allow you to breathe. Occasionally, the small elastic bands become damaged, which impacts breathing, speaking, eating and coughing, according to Cleveland Clinic. Voice exercises to strengthen vocal cords aim to help you regain control of your vocal cords and throat.

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Read more: 4 Good Foods and 3 Bad Foods for Your Voice

Vocal Cord Strengthening Exercises

If the damage to your vocal cords has caused them to become weak, strengthening exercises may help your condition. Pronouncing words and phrases that begin with a vowel tend to be the best exercises for activating the vocal cords. The Aurora Health Care website recommends repeating the phrase "Ah-Ah-Ah" with a hard onset 10 times at least three times per day. Throughout the day, challenge yourself to repeat words that begin with vowels, such as "upstairs, elephant, ignore, accident and owl." As you say the words, try to emphasize the first sound.

Add the Push/Pull Technique

If you are having trouble clearly enunciating the words or phrases used in the strengthening exercises, consider combining them with the push-pull technique. Pushing or pulling up against seat of a chair while simultaneously repeating the "Ah-Ah-Ah" phrase to make the exercise more effective. The push/pull movements are thought to encourage closing of the vocal cords, which helps in pronunciation.

Clear Your Throat

The Ohio State University Wexner Medical Center recommends a "supraglottic swallow maneuver," which can help clear the throat in preparation of speech.

• Turn your head toward the side of the damaged vocal cords. If vocal cords on both sides are damaged, simply leave the head pointing forward.
• Hold your breath tightly while swallowing.
• Then, cough immediately after swallowing before exhaling.

The throat is cleared during the swallowing phase, while the coughing phase helps bring the vocal cords closer together.

Read more: Voice Training Exercises for Beginners

Relax the Throat

Learning how to relax the throat can help you maintain control of your breathing and damaged vocal cords.

• Lie on the ground with your knees bent and feet flat on the ground.
• lace your hand on your abdomen as you inhale slowly through the nose and exhale slowly through pursed lips.
• Watch your hand as it moves up and down with each breath.
• Alter the speed of your inhalations and exhalations, keeping the throat relaxed with each breath.

As you become familiar with the exercise, practice breathing in upright, squatting, leaning forward and bent over positions.

• Aurora Health Care: "Vocal Cord Strengthening Exercises (PDF)"
• Cleveland Clinic: "Vocal Cord Dysfunction"
• The Ohio State University Wexner Medical Center: "Supraglottic Swallowing Method"

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Having a rare medical problem changed me as a doctor

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Something strange began happening to my voice a few months after my father died in 2000. My speech became halting and stuttering in quality, like having stage fright with everyday conversation.

The first ear, nose and throat doctor I saw told me that my voice problem was stress-related. But because my vocal cords appeared inflamed, I was referred to a gastroenterologist to address reflux and to an allergist to deal with allergies. After treatment for both issues, my voice was no better.

A different ENT doctor referred me for speech therapy. I was thrilled that the therapist made weekly home visits. But after three visits, she decided to stop working with me because, despite her efforts, her interventions were ineffective.

I felt devastated. I sought out third, fourth and fifth opinions from other ENT and speech specialists. A speech pathologist at one hospital took a video recording of my vocal cords and discovered that one of the cords appeared shrunken. Following an opinion from a laryngeal specialist, I consented to have a Gore-Tex vocal cord implant. Sadly, I was worse following the surgery.

Post-op, I received speech therapy twice a month for one year, but my voice spasms did not improve. The only remedy that provided temporary relief was intense exercise. If I ran five or six miles, my voice would be relatively normal for one to two hours. I wished I could live on a treadmill.

After seven years of dealing with my voice disorder, a new speech pathologist arrived at my hospital. He analyzed a spectrogram, or a visual representation of how my voice sounded, and noted a particular pattern indicative of a rare vocal cord condition called laryngeal dystonia . My ENT doctor then confirmed the diagnosis, as did a dystonia specialist at UCSF. 

The treatment for this condition was Botox injections directly into my vocal cords. An odd thing happened shortly before the first Botox injection. Immediately after I introduced myself to a new patient, she exclaimed, “You have laryngeal dystonia!” She had been successfully treated for this at UCLA and recognized my speech pattern right away.

My first Botox injection brought a miraculous recovery of my voice that lasted for two months. When I returned for a second injection the doctor said he would give me a higher dose with the hope that the effect would last longer. Following the high-dose injection, my vocal cords became totally paralyzed, and I was mute for a week before my voice gradually returned to normal. Several months later, when I expected the Botox to have worn off, I was amazed that the dystonia didn’t recur.

What did I learn from this experience? Probably not what you expect. 

First off, I learned to really listen.

A 2019 study revealed that patients speak for an average of 11 seconds before they are interrupted by their doctors. Time is precious, and doctors are rushed. 

Because of my voice impairment, I tried to speak as little as possible. By not interrupting my patients, I found that most answers to my questions eventually were revealed. Office visits became more efficient and relaxed, and I became fully present by focusing attention on my patients’ words and demeanor. One patient spoke nonstop for three minutes. When she realized she had not been interrupted, she remarked, “Wow, that’s never happened to me before!”

According to the National Institutes of Health, there are more than 7,000 rare diseases . Cumulatively, this equates to one in 10 Americans with one. It can be hard for doctors to diagnose a rare medical problem, particularly if they have never seen it before — or, in my case, heard it. So I also learned that as a patient, it’s important to persistently ask, “What else can be causing my problem?” 

In addition, I became more hesitant to blame a patient’s issue on stress until I fully investigated other possibilities.

It is tough to live with a lingering medical issue. Thinking back to my own difficult experience, I periodically ask patients who live with a chronic medical problem about how it affects the quality of their lives. 

In the midst of my own illness, I also looked for opportunities to express gratitude. I remain grateful today for my wife and for all of the doctors and speech therapists who tried their best to help me over so many years.

Jerry Saliman, MD, retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.

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