Imagine getting up one fine morning with no voice. A term referred to in medical circles as “Aphonia”. That’s exactly what happened to Tanya (name changed) one week ago due to paralysis of one of her vocal folds. In her case the diagnosis of “idiopathic vocal fold palsy” has been made, which is another way of saying that we brilliant doctors are clueless about the reason behind the immobility of her vocal fold!

Humans have two vocal folds shaped like a “V” at the inlet of the breathing pipe that open and let air through to the lungs for us to breathe and close and vibrate allowing us to talk or phonate. When the movement of one vocal fold, or worse both, is affected, a large gap between the two allows air leak from the wind pipe resulting in a breathy or absent voice.

In Tanyas case the reason in all probability is a viral infection, more common in the monsoons. There is however no reason for alarm as paralysis of the vocal folds occurs in a very small percentage of individuals. Recovery usually does take place but may take from 6months to 18 months. Tanya has been advised a period of speech therapy, akin to physiotherapy, but for the voice muscles. If her voice does not come back with this therapy then a surgery called “thyroplasty” shall be performed where an implant is placed in the voice box to push the immobile vocal fold and close off the gap between the folds with an immediate return of the voice! The results of the surgery are very gratifying for both the patient and the surgeon as the entire surgery is done with the patient awake so as to “tailor make” the voice to the satisfaction of both.

It is essential to rule out cancer or tuberculosis, both of which are common in the Indian population, by doing a CT scan. Mangesh, a 7 year old boy who had a breathy voice since 6 months was detected with large tuberculous lymph nodes in the chest pressing on the nerve supplying the vocal fold. Following medical treatment for tuberculosis his voice is improving.

Occasionally patients may develop vocal fold weakness following thyroid, heart, spine or food pipe surgery.

One of the commonest causes of a voice change however is acute infection i.e. Laryngitis which settles with voice rest and medicines. Vocal nodules, also known as teachers, singers or screamers nodules are seen more commonly in professional voice users and people who abuse their voice.

It is advisable to visit an ENT specialist for a voice change persisting for over 3-4 weeks.

Not all cases of an immobile vocal fold however are due to infection, tumour or surgery.

The most recent patient I had the occasion of performing Thyroplasty surgery on had come to me with a complete loss of voice following an accidental fall on his bedpost injuring his neck. A CT Scan showed a fracture with fixation of one of the vocal folds. Since he was a call center employee, he lost his job promptly and was desperate for his “voice”. Happily for this patient, following his surgery, he is today with a job and a voice to go with it!

Dr Nupur Kapoor Nerurkar
M.S. (ENT)
Laryngologist and Voice Surgeon
Bombay Hospital and Medical Research Center