Vocal Cord Paralysis vs. Paresis: Key Differences, Symptoms, and Treatments

When James, a podcast host, noticed his voice cracking mid-recording, he assumed it was overuse. But when his ENT mentioned vocal cord paresis—partial weakness of the vocal cords—he realized not all voice disorders are the same. Paralysis and paresis are often confused, yet their impact on speech, breathing, and quality of life varies dramatically. Let’s unravel their differences and uncover pathways to recovery.

Paralysis vs. Paresis: What’s the Difference?

Vocal Cord Paralysis

• Definition: Complete loss of movement in one or both vocal cords.

  • ICD-10 Codes: Unilateral: J38.01, Bilateral: J38.02

  • Severity: Often linked to nerve damage (e.g., recurrent laryngeal nerve injury).

Vocal Cord Paresis

• Definition: Partial weakness or reduced mobility of the vocal cords.

  • ICD-10 Code: J38.3 (vocal cord weakness, unspecified).

  • Severity: Less severe than paralysis but can progress if untreated.

Symptoms: How They Compare

Shared Symptoms

• Hoarseness

• Voice fatigue

• Difficulty projecting speech

Unique to Vocal Cord Paralysis

1. Breathing Issues:

• Bilateral vocal cord paralysis often causes stridor (high-pitched breathing) or airway obstruction.

• Example: A newborn with bilateral vocal cord paralysis at birth may require a tracheostomy.

2. Severe Aspiration Risk: Weak cough reflex increases choking hazards.

Unique to Vocal Cord Paresis

1. Intermittent Symptoms: Voice may improve with rest.

2. Mild Airflow Issues: Rarely causes stridor but may lead to shortness of breath during exertion.

Case Study: Emily, a teacher with left vocal cord paresis, could speak clearly in the morning but lost her voice by afternoon. Therapy focused on reducing muscle strain.

Causes: From Nerve Damage to Infections

Vocal Cord Paralysis Causes

1. Surgery: Thyroidectomy (25-30% of cases).

2. Trauma: Neck injuries or prolonged intubation.

3. Neurological: Stroke, ALS, or COVID vocal cord paralysis (rare but documented).

Vocal Cord Paresis Causes

1. Overuse: Chronic voice strain (common in singers).

2. Neuropathy: Early-stage nerve compression (e.g., from acid reflux).

3. Idiopathic: No identifiable cause in 15-20% of cases.

Key Insight:

Paresis is often a precursor to paralysis. For instance, partial paralysis of the vocal cords might begin as paresis before nerves fully degrade.

Diagnosis: Imaging, Scopes, and Voice Analysis

Shared Diagnostic Tools

• Laryngoscopy: Visualizes cord movement.

• CT/MRI: Rules out tumours (e.g., vocal cord paralysis radiology).

Differentiating Tests

1. Electromyography (EMG):

• Measures nerve activity.

• Paresis shows reduced signals; paralysis shows none.

2. Flow Volume Loop:

• Bilateral vocal cord paralysis creates a “fixed obstruction” pattern.

• Paresis may show minor airflow irregularities.

Example: A patient with abductor paralysis of vocal cords (cords stuck closed) had a flat inspiratory flow loop, while paresis showed fluctuating waves.

Treatment: Tailoring Solutions to Severity

For Paralysis

1. Surgery:

• Vocal cord paralysis surgery (e.g., thyroplasty, injection laryngoplasty).

• Bilateral vocal cord paralysis treatment** may require cordectomy or tracheostomy.

2. Voice Therapy:

• Post-surgery exercises with a Speech Pathologist to optimize function (vocal cord paralysis exercises PDF).

For Paresis

1. Voice Rest and Therapy:

• Speech therapy for vocal cord paralysis/paresis focuses on reducing strain.

• Techniques like “straw phonation” improve airflow.

2. Medications:

• Steroids for inflammation.

• Antivirals if linked to infections (e.g., Lyme disease).

Success Story: After vocal cord paralysis therapy, Mark transitioned from paresis to full mobility in 6 months.

Living with Paralysis vs. Paresis

Paralysis Challenges

• Airway Management: Severe cases need tracheostomy.

• Diet Modifications: Thickened liquids to prevent aspiration.

Paresis Adjustments

• Voice Conservation: Amplification devices for professionals.

• Lifestyle Tweaks: Avoiding caffeine (dries vocal cords).

Tip for Parents:

Feeding a baby with vocal cord paralysis requires specialized bottles; paresis may only need slower feeds.

FAQs: Your Top Questions Answered

Q: Can paresis become paralysis?

A: Yes, if underlying nerve damage progresses (e.g., untreated tumours).

Q: Is vocal cord paresis curable?

A: Often reversible with early intervention (e.g., vocal cord paralysis treatment, speech therapy).

Q: How are they coded differently?

A: Paralysis uses J38.0x; paresis falls under J38.3.

Final Thoughts

Understanding the line between paralysis and paresis empowers better care. While paralysis demands urgent, sometimes surgical action, paresis offers a window for preventive therapy. Whether you’re battling unilateral vocal cord paralysis or mild paresis, modern medicine and therapy can help you find your voice again.

Consult a Speech Pathologist or ENT specialist if you experience persistent hoarseness.