Causes of bilateral vocal fold paralysis include stroke or other neurologic conditions (especially a childhood condition known as Arnold-Chiari malformation), thyroid cancer, or surgery such as major brain surgery or thyroidectomy. Symptoms of bilateral vocal fold paralysis includes difficulty breathing, which increases with effort; people with this condition may find that they are severely restricted in how far they can walk, or in how heavy a load they can carry. Often there is a wheezy noise when breathing, which can cause this condition to be mistaken for asthma. Asthma that fails to improve with appropriate medicines and inhalers requires that a physician examine the larynx and vocal folds.

Diagnosis is generally based on the patient’s history and an examination of the vocal folds with an endoscope. Occasionally, an electromyogram (EMG) test may be necessary to evaluate the neurologic status of the larynx.

Treatment of bilateral vocal fold paralysis often requires making some difficult choices. As is true in all voice disorders, nothing can take the place of a detailed discussion with your treatment team. The main issue in the treatment of bilateral vocal fold paralysis is whether or not the vocal folds are far enough apart to allow safe breathing. In many cases, the safest initial treatment is a tracheostomy—a breathing hole directly into the windpipe—to guarantee the airway until other plans are made.

There are procedures (such as arytenoidectomy and cordotomy) to allow adequate airway and permit removal of the tracheostomy. However, all of these may cause some deterioration of voice quality, and sometimes may create problems swallowing.