Automobile collisions, work, sports, and personal accidents can cause neck injuries that can affect other areas, leading to long-term health problems. Neck injuries involving soft tissue damage frequently persist after the incident. One of the injuries includes vocal cord damage caused by impact to the larynx. The larynx, or voicebox, is an organ that is behind the Adam’s apple. A neck injury impacting the larynx can affect the ability to speak and breathe and cause vocal cord paralysis. Treatment can involve surgery, voice therapy, physical therapy, and chiropractic.

Vocal Cord Injury

The vocal cords are two flexible bands of muscle tissue at the entrance of the trachea. The vocal cords are normally in a relaxed open position to allow breathing. When talking, the bands combine and vibrate to make a sound. Surgery, viral infections, certain cancers, and neck trauma can cause vocal cord paralysis. In this condition, nerve damage blocks or inhibits impulses from transmitting to the voice box. The muscles, usually one of them, become paralyzed, preventing swallowing and ingesting saliva through the windpipe/trachea. In rare cases, both muscles are unable to move.

Symptoms

Signs and symptoms can include:

• Difficulty breathing
• Shortness of breath.
• Hoarse breathing.
• Noisy breathing.
• Speaking problems
• The need to take frequent breaths while speaking.
• Loss of vocal pitch.
• Inability to talk loudly.
• Trouble Swallowing
• Choking or coughing when swallowing.
• Loss of gag reflex.
• Frequent coughing and throat clearing.

Causes

Neck or Chest Injury

• Trauma to the neck or chest can injure the voice box nerves.

Infections

• Infections like Lyme disease, Epstein-Barr virus, and herpes can cause inflammation and nerve damage.

Tumors

• Tumors, cancerous and noncancerous, can grow inside or around the muscles, cartilage, and nerves.

Neurological

• Neurological conditions like multiple sclerosis or Parkinson’s disease can lead to vocal cord paralysis.

Surgical Injury

• Surgical procedure mistakes or complications on or near the neck or upper chest can result in damage to the voice box nerves.
• Surgeries to the thyroid or parathyroid glands, esophagus, neck, and chest have an increased risk.

Stroke

• A stroke chokes blood flow to the brain and can damage the region of the brain that transmits messages to the voice box.

Treatment

Treatment is determined by a doctor based on the individual medical condition and diagnostic tests. Treatment can involve:

Speech Therapy

Speech therapy is recommended as the laryngeal muscles are strengthened through various exercises, improving breathing function. A speech therapist will begin working with the individual on exercises targeting the weakened vocal folds by enhancing airflow and blood circulation.

Physical Therapy and Chiropractic

Treatment involves performing gentle exercises that work on the vocal cords gradually and progressively but does not stress them. Chiropractors work with the physical therapist performing high-velocity, low-amplitude manipulation targeted at the lower neck and upper thoracic area, the C3/T1 vertebrae. A treatment plan will also use massage, non-surgical decompression, instrument/tool-assisted soft-tissue mobilization, low laser or ultrasound, and at-home stretches and exercises.

Surgery

Surgery could be necessary for individuals experiencing no improvement despite doing the prescribed speech and physical therapy exercises. Different types of procedures are based on the degree and extent of the paralysis:

• Injections – Collagen and fillers are injected into the vocal cords to reposition the affected muscles closer to the larynx.
• Phonosurgery – The vocal cords are repositioned through restructuring.
• Tracheotomy – If the vocal folds are closing, a surgeon may make an incision in the neck at the opening of the windpipe and insert a breathing tube. This bypasses the air blockage caused by the vocal folds and promotes proper air circulation.

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Cervical Spine Instability

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References

Chen, Ching-Chang, et al. “Long-term result of vocal cord paralysis after anterior cervical discectomy.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 23,3 (2014): 622-6. doi:10.1007/s00586-013-3084-y

Dankbaar JW, et al. Vocal cord paralysis: Anatomy, imaging, and pathology. Insights in Imaging. 2014; doi:10.1007/s13244-014-0364-y.

Fitzpatrick, P C, and R H Miller. “Vocal cord paralysis.” The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society vol. 150,8 (1998): 340-3.

Kriskovich, M D et al. “Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury.” The Laryngoscope vol. 110,9 (2000): 1467-73. doi:10.1097/00005537-200009000-00011

Vocal fold paralysis. National Institute on Deafness and Other Communication Disorders. www.nidcd.nih.gov/health/vocal-fold-paralysis. Accessed May 18, 2022.

Vocal fold paralysis. American Speech-Language-Hearing Association. www.asha.org/public/speech/disorders/Vocal-Fold-Paralysis. Accessed May 18, 2022.

Waddell, Roger K. “Chiropractic care for a patient with spasmodic dysphonia associated with cervical spine trauma.” Journal of chiropractic medicine vol. 4,1 (2005): 19-24. doi:10.1016/S0899-3467(07)60108-6