What is vocal cord paresis/palsy?

The vocal cords are two small muscles located in your larynx (voice box) that are responsible for voice production.

Vocal cord paresis and palsy result from a change in your nerve supply input to your voice box muscles. Palsy is the total interruption of nerve supply, resulting in no vocal cord movement. Paresis is the partial interruption of nerve supply, resulting in weak or abnormal movement of your vocal cord(s).

The common causes are head and neck injury, surgery, tumours, disease and stroke.

When one vocal cord does not move, or is weak, your vocal cords will find it difficult to meet in the middle. This will depend on the position in which your vocal cord is stuck.  When your vocal cords cannot close properly, there may be a gap between the two vocal cords causing a breathy, hoarse voice.

Vocal cord palsy/paresis can affect one or both of your vocal cords.  If both your vocal cords are not moving, medical treatment is often needed to help protect your airway.

Figure of two vocal cords, the first in a normal closed position, the other slightly open due to vocal palsy.
Figure of two vocal cords, the first in a normal closed position, the other slightly open due to vocal palsy.

Images courtesy of Lucian Sulica, MD, www.voicemedicine.com

Signs and symptoms of vocal cord palsy

  • Your voice may be weak, breathy and whispery.
  • It may be difficult to talk when there is background noise.
  • Your voice becomes tired with use and lacks stamina.
  • You may get short of breath when talking.
  • In severe cases, when the vocal cord is stuck in a more open position, food and drink can go down the wrong way causing coughing or choking.

What are the treatment options?

Speech Pathologists can give you exercises and advice to help your vocal cords work in new ways that do not cause any new damage.  They can help you improve your breath support, pitch and volume to maximise your voice and reduce effects such as muscle tightening and straining.

Your Speech Pathologist may check your swallowing and give advice and tips to help stop food and drink going down the wrong way.

In some cases surgery is a treatment for vocal cord palsy.  Surgery can help your vocal cords meet in the middle and can improve your voice and swallowing.

General advice to help look after your voice

  • Avoid shouting and whispering.
  • Do not whisper to try to get a stronger voice as his can make the muscles in your throat tight, and make it more difficult to talk.
  • Try not to sing loudly, strain or force your voice.
  • Avoid talking for prolonged periods of time, particularly over background noise.
  • Avoid clearing your throat and coughing harshly. If you have to clear your throat, do this gently and sip water.
  • Avoid smoking and smoky environments.
  • Avoid drinking spirits or wine as these will dry the throat.
  • Avoid talking when your throat is dry or uncomfortable especially in hot, dry, dusty and smoky atmospheres.
  • Minimise hot caffeinated drinks and spicy foods as these cause dehydration and remove mucus from the throat.
  • Sip water regularly – good hydration is essential for good voice quality.
  • Try steam inhalation – this will help rehydrate the larynx as well as relax tight muscles in the throat. Use plain water only – no menthol or eucalyptus.


Disclaimer This document describes the generally accepted practice at the time of publication only. It is only a summary of clinical knowledge regarding this area. The Royal Victorian Eye and Ear Hospital makes no warranty, express or implied, that the information contained in this document is comprehensive. They accept no responsibility for any consequence arising from inappropriate application of this information.

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  • Vocal Cord Palsy #62
  • Owner: Speech Pathology
  • Last Reviewed: April 6, 2023
  • Next Review: April 6, 2028