speech therapy exercises for paralyzed vocal cord

Paralyzed Vocal Cord Exercises

Ken Tamplin, Professional Vocal coach

Reviewed by Editorial Team

Updated on December 18, 2023

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Table of Contents

Improved speech clarity.

Paralyzed vocal cords can significantly impact speech clarity, making it difficult to communicate effectively. However, incorporating specific exercises into your routine can help improve speech clarity. One effective exercise is straw phonation. This involves making sounds while exhaling through a straw, which helps to strengthen the vocal cords and improve their coordination. Another beneficial exercise is vocal cord adduction exercises, which involve practicing making sounds by bringing the vocal cords together. These exercises can help to enhance the strength and coordination of the vocal cords, leading to improved speech clarity over time.

Straw Phonation Exercise

Straw phonation is a widely used exercise to improve speech clarity in individuals with paralyzed vocal cords. To perform this exercise, you will need a straw. Begin by taking a deep breath and exhaling gently through the straw while making a continuous “humming” sound. This exercise helps to provide resistance to the airflow, promoting better closure and coordination of the vocal cords.

Vocal Cord Adduction Exercises

Vocal cord adduction exercises involve practicing making sounds that require bringing the vocal cords together, such as saying “ee” or “oo.” These exercises aim to train the vocal cords to come together effectively, which is essential for improved speech clarity.

Enhanced Swallowing Function

Paralyzed vocal cords can also impact swallowing function, leading to difficulties in eating and drinking. However, specific exercises can help enhance swallowing function and reduce the risk of aspiration. One effective exercise is the Mendelsohn maneuver, which involves swallowing and holding the throat muscles in a raised position for a few seconds. This exercise helps to strengthen the muscles involved in swallowing, leading to improved swallowing function over time.

Mendelsohn Maneuver

To perform the Mendelsohn maneuver, start by swallowing while focusing on the upward movement of your throat muscles. Hold your throat muscles in the raised position for a few seconds before relaxing. Practicing this maneuver regularly can help strengthen the muscles involved in swallowing, leading to enhanced swallowing function.

Psychological Benefits of Vocal Cord Exercise

Engaging in vocal cord exercises not only offers physical benefits but also provides psychological advantages. Individuals with paralyzed vocal cords often experience frustration and a sense of loss due to communication difficulties. By actively participating in vocal cord exercises, individuals can regain a sense of control over their voice and communication abilities. Additionally, as speech clarity and swallowing function improve, individuals may experience a boost in confidence and overall well-being.

Practical Tips and Advice

Setting realistic goals for vocal cord rehabilitation.

When embarking on vocal cord rehabilitation, it is essential to set realistic goals to track progress effectively. Speak with a speech-language pathologist to gain insights into what to expect and how to set achievable milestones. Setting realistic goals can help maintain motivation and provide a clear path toward vocal cord rehabilitation.

Tracking Progress and Adapting Exercise Regimen

Tracking progress is crucial in vocal cord rehabilitation. Keep a journal to document improvements in speech clarity and swallowing function. Additionally, be open to adapting your exercise regimen based on your progress. Consult with your speech-language pathologist to make necessary adjustments to your exercises and techniques as you progress through rehabilitation.

Integrating Vocal Therapy Techniques into Daily Activities

To maximize the benefits of vocal cord exercises, consider integrating vocal therapy techniques into your daily activities. Practice speaking exercises during conversations with friends and family, and incorporate swallowing exercises with meals. By integrating these exercises into daily activities, you can make consistent progress in vocal cord rehabilitation.

In conclusion, engaging in paralyzed vocal cord exercises can significantly improve speech clarity, enhance swallowing function, and provide psychological benefits. Incorporating exercises such as straw phonation, vocal cord adduction exercises, and the Mendelsohn maneuver can lead to positive outcomes in vocal cord rehabilitation. By setting realistic goals, tracking progress, and integrating vocal therapy techniques into daily activities, individuals can effectively work towards improving their vocal cord function and overall quality of life.

1. How often should I perform vocal cord exercises?

It is recommended to perform vocal cord exercises as advised by your speech-language pathologist. Typically, exercises may be performed daily or as per a specific schedule tailored to your rehabilitation plan.

2. Can vocal cord exercises completely restore vocal cord function?

While vocal cord exercises can lead to significant improvements in vocal cord function, the extent of restoration varies among individuals. Consistency and adherence to the recommended exercises play a crucial role in achieving positive outcomes.

3. Are there any dietary restrictions during vocal cord rehabilitation?

Your speech-language pathologist may provide specific dietary recommendations based on your swallowing function. It’s essential to follow any dietary guidelines provided to support your vocal cord rehabilitation.

4. Can vocal cord exercises help with breath control during speech?

Yes, vocal cord exercises can contribute to improved breath control during speech by strengthening the muscles involved in vocalization. As speech clarity improves, individuals may also notice enhanced breath control.

5. How long does it take to see improvements from vocal cord exercises?

The timeline for seeing improvements from vocal cord exercises varies for each individual. Some may notice improvements within a few weeks, while others may require a longer duration. Consistent practice and adherence to the exercise regimen can contribute to positive outcomes over time.

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A Comprehensive Guide on Paralyzed Vocal Cord Exercises

• By Casey Monroe
• Published on November 2, 2024

Dealing with paralyzed vocal cords can be frustrating and affect your daily life. Communication becomes challenging, and you might feel helpless.

But there’s good news – with the right approach, you can improve your voice and quality of life.

This guide will show you effective exercises to help recover your voice after vocal cord paralysis.

We’ll explore simple techniques recommended by speech therapists, explain how these exercises work, and provide step-by-step instructions for each one.

Whether you’re dealing with a recent diagnosis or long-term effects, you’ll find valuable information to support your voice recovery journey.

Let’s get started on the path to better communication and confidence.

What is Vocal Cord Paralysis?

Vocal cord paralysis happens when one or both vocal cords can’t move as they should.

This condition occurs when the nerve controlling the muscles in your voice box gets damaged.

Various factors can lead to this, such as surgery complications, neck or chest injuries, or certain medical conditions.

People with vocal cord paralysis often experience a weak or breathy voice. You might find it hard to speak loudly or for long periods.

Other signs include trouble swallowing, feeling like food goes down the wrong way, or becoming short of breath during physical activities.

Vocal cord exercises are key to improving your voice. They help strengthen the working parts of your voice box and teach you how to use your voice more effectively.

They’re an important part of the healing process, helping to improve your voice quality and make daily tasks easier.

Immediate Exercises for Paralyzed Vocal Cords

When dealing with vocal cord paralysis, immediate action is crucial to prevent further strain and promote healing.

Below are three highly effective exercises for relaxing, strengthening, and improving the function of the vocal cords.

1. Paused Breathing Exercise

Step-By-Step Guide:

• Position: Sit upright with your neck and shoulders relaxed but your back straight. Make sure you’re seated in a calm environment where you can focus solely on your breathing.
• Inhale: Gently breathe in through your nose, allowing the air to flow naturally.
• Exhale: Stick your tongue out past your teeth and lips, ensuring the airway is fully open. Exhale slowly, spacing out your breaths in a rhythmic manner. Imagine saying “Ha, ha, ha” softly but without using your voice.
• Repetition: Perform this exercise 10 times, 3 times a day.

How It Helps: This exercise reduces tension around the vocal cords and helps align their movement. It also promotes proper closure during exhalation, essential for healthy vocal function.

It’s especially useful during spasms or moments of vocal strain, as it teaches the cords to stay open and relaxed, easing airflow.

2. Belly Breathing Exercise

• Position: Sit in a comfortable, upright position with your neck and shoulders relaxed. Place one hand on your belly to monitor your breathing.
• Inhale: Breathe deeply through your nose, letting your belly expand and push your hand outward.
• Exhale: As you exhale, place the tip of your tongue against the roof of your mouth near your front teeth. Slowly release the air, making a soft hissing or “S” sound.

How It Helps: Belly breathing strengthens the diaphragm, which in turn supports better breath control and coordination of the vocal cords.

This exercise helps ensure that you are not relying solely on your throat muscles for sound production, reducing the strain on the vocal cords.

It’s an excellent technique for building lung capacity and ensuring smoother, more controlled exhalation, essential for clear, strong vocalization.

3. Humming Exercise

• Start with a relaxed posture: Sit or stand comfortably with your shoulders relaxed.
• Gentle hum: Close your lips and start humming softly. Focus on the gentle vibration created in your throat. Start with lower tones and gradually move to higher tones as your voice warms up.
• Vary the pitch: Experiment with different pitches, focusing on keeping the hum smooth and steady.
• Repetition: Hum for about 5 minutes, several times a day, ensuring there is no strain on your vocal cords.

How It Helps: Humming encourages vocal cord vibration, which can stimulate healing and improve flexibility.

It helps with voice modulation, especially for those experiencing pitch instability or weakness. Regular humming exercises can enhance vocal strength, making speech clearer and less effortful.

Key Considerations During Recovery

During vocal cord recovery, it is important to combine proper rest with therapeutic interventions to ensure long-term success and prevent further strain.

1. Rest and Voice Therapy Integration

Resting your voice is vital for recovery from vocal cord paralysis. Your vocal cords need time to heal; overuse can slow down this process.

Voice Rest Tips:

• Follow your doctor’s advice on rest duration
• Minimize speaking and avoid forceful voice use
• Steer clear of both whispering and loud speaking

Working with a Speech Therapist:

• Get personalized exercises tailored to your needs
• Benefit from professional guidance for safe recovery
• Receive ongoing progress monitoring and adjustments

2. Hydration and Diet Adjustments

Proper hydration and diet play crucial roles in your recovery process.

Keeping Vocal Cords Hydrated:

• Drink at least 8 glasses of water daily
• Limit caffeine and alcohol intake
• Use a humidifier to maintain air moisture

Dietary Tips:

• Choose easily swallowed-foods
• Avoid mixing solids with liquids
• Eat slowly and take smaller bites
• Sit upright while eating to prevent aspiration

By following these guidelines, you can support your vocal cord recovery and minimize potential complications.

Diagnosis and Long-Term Solutions

Accurate diagnosis of vocal cord paralysis is crucial for effective treatment. Doctors use laryngoscopy to view the vocal cords directly, while electromyography measures nerve activity in the muscles.

Imaging tests like CT and MRI scans help identify underlying causes. For long-term management, non-surgical options often prove effective.

Voice therapy, led by a speech-language expert, helps strengthen the working vocal cords and improve breathing techniques. This approach can significantly enhance voice quality and reduce symptoms.

In some cases, vocal cord injections offer a temporary solution by moving the affected cord closer to the center, improving voice function.

These methods, alone or combined, can provide substantial relief and better vocal control for many patients.

Preventative Measures and Coping Strategies

1. lifestyle adjustments.

Taking care of your vocal health involves making some changes to your daily routine. Try to lower stress through calming activities like deep breathing or gentle stretching.

It’s also wise to stay away from places where you might need to raise your voice, such as crowded, noisy areas.

These small changes can make a big difference in protecting your vocal cords.

2. Long-Term Strategies for Vocal Health

To keep your voice strong over time, stick to a routine of vocal exercises suggested by your speech expert.

Pay attention to how your voice feels – if you notice any discomfort or changes in your voice quality, take it as a sign to rest your voice and seek advice if needed.

By staying alert to these signs, you can act quickly to prevent further issues and maintain good vocal health.

Wrapping It Up

As we wrap up our voice recovery guide, remember that healing takes time and patience. Your journey to better vocal health is personal, and progress may come in small steps.

Stay committed to your exercises and follow your healthcare team’s advice. Don’t hesitate to ask questions or seek support when needed.

While your voice may not return to its exact pre-paralysis state, many people achieve significant improvements with dedication and proper care.

Your voice is an essential part of who you are, and with the right approach, you can adapt, grow, and continue to express yourself effectively.

Keep working towards your goals, and celebrate each milestone along the way.

Casey Monroe

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To diagnose vocal cord paralysis, your healthcare professional asks about your symptoms and lifestyle. Your care professional also listens to your voice and asks how long you've had voice changes. You also may need the following tests:

Laryngoscopy. Your healthcare professional looks at your vocal cords using a mirror or a thin, flexible tube known as a laryngoscope or endoscope, or both. You also may have a test called videostrobolaryngoscopy. It uses a special scope that contains a tiny camera at its tip or a larger camera connected to the scope's viewing piece.

These special high-magnification endoscopes allow your healthcare professional to view your vocal cords directly or on a video monitor. The tests reveal the movement and position of the vocal cords. This can tell your healthcare professional whether one or both vocal cords are affected.

Laryngeal electromyography. This test measures the electrical currents in your voice box muscles. To do this, small needles are inserted into the vocal cord muscles through the skin of the neck.

This test isn't used to guide treatment, but it may give an estimate about how well you may recover. This test is most useful when it's done between six weeks and six months after your symptoms began.

• Blood tests and scans. Several diseases may cause nerve injuries. You may need additional tests to find the cause of the paralysis. Tests may include bloodwork, X-rays, MRI or CT scans.

More Information

• Electromyography (EMG)
• Upper endoscopy

Treatment of vocal cord paralysis depends on the cause, how serious the symptoms are and when symptoms began. Treatment may include voice therapy, bulk injections, surgery or a combination of treatments.

In some instances, you may get better without surgical treatment. For this reason, your healthcare team may delay permanent surgery for at least a year from the beginning of your vocal cord paralysis.

However, surgical treatment with various bulk injections is often done within the first three months of voice loss.

During the waiting period for surgery, you may get voice therapy to help keep you from using your voice improperly while the nerves heal.

Voice therapy

Voice therapy sessions involve exercises or other activities to strengthen your vocal cords and help improve breath control during speech. Voice therapy also can prevent tension in muscles around the paralyzed vocal cord or cords, and protect your airway during swallowing. Voice therapy may be the only treatment needed if the paralysis occurs in an area that doesn't require additional bulk or repositioning.

If your vocal cord paralysis symptoms don't fully recover on their own, you may need surgery to improve your ability to speak and to swallow.

Surgical options include:

• Bulk injection. Paralysis of the nerve to your vocal cord will probably leave the vocal cord muscle thin and weak. A doctor who specializes in disorders of the larynx, known as a laryngologist, may add bulk to the paralyzed vocal cord. This is done by injecting the vocal cord with a substance such as body fat, collagen or another approved filler substance. This added bulk brings the affected vocal cord closer to the middle of the voice box. Then the functioning vocal cord can make closer contact with the paralyzed cord when you speak, swallow or cough.
• Structural implants. This procedure relies on the use of an implant in the larynx to reposition the vocal cord. The procedure also is known as thyroplasty, medialization laryngoplasty or laryngeal framework surgery. Rarely, people who have this surgery may need to have a second surgery to reposition the implant.
• Vocal cord repositioning. In this procedure, a surgeon moves a window of your own tissue from the outside of your voice box inward, pushing the paralyzed vocal cord toward the middle of your voice box. This allows your functioning vocal cord to better vibrate against the paralyzed vocal cord.
• Replacing the damaged nerve, known as reinnervation. In this surgery, a healthy nerve is moved from a different area of the neck to replace the damaged vocal cord. It can take as long as 6 to 9 months before your voice gets better. This surgery is sometimes combined with a bulk injection.

Tracheotomy. If both of your vocal cords are paralyzed and positioned closely together, your airflow will be decreased. This causes a lot of trouble breathing and requires a surgery called a tracheotomy.

A cut is made in the front of your neck to create an opening in the windpipe, also known as the trachea. A breathing tube is inserted, allowing air to bypass the vocal cords.

Emerging treatments

Linking the vocal cords to another source of electrical stimulation may restore opening and closing of the vocal cords that can't move. Other sources of electrical stimulation might be a nerve from another part of the body or a device similar to a cardiac pacemaker. Researchers continue to study this and other options.

Coping and support

Vocal cord paralysis can be frustrating and affect your daily life. It can be hard to communicate with other people. A speech therapist can help you develop the skills you need to communicate.

Even if you're not able to get back the voice you once had, voice therapy can help you learn effective ways to make up for it. In addition, a speech-language pathologist can teach you how to use your voice without causing further damage to the vocal cords.

Preparing for your appointment

You're likely to first see your healthcare professional about vocal cord paralysis. But if both vocal cords are paralyzed, you'll probably first be seen in a hospital emergency department.

After the initial assessment, you'll likely be referred to a doctor who specializes in ear, nose and throat conditions. You also may be referred to a speech-language pathologist for voice assessment and therapy.

It's helpful to arrive well prepared for your appointment. Here's some information to help you get ready and what to expect.

What you can do

• Write down any symptoms you're experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent illnesses or life changes.
• Make a list of all medicines, vitamins or supplements that you're taking, including the dose of each.
• Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who is with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare professional may be limited. Preparing a list of questions can help you make the most of your time together. For vocal cord paralysis, some basic questions to ask include:

• What's the most likely cause of my vocal cord paralysis?
• What kinds of tests do I need? Do these tests require any special preparation?
• Is this condition temporary, or will my vocal cords always be paralyzed?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the treatment that you're suggesting?
• Are there any restrictions on using my voice after treatment? If so, for how long?
• Will I be able to talk or sing after treatment?
• Are there any brochures or other printed material that I can take home with me?

In addition to the questions that you've prepared to ask, don't hesitate to ask any additional questions that occur to you during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you a number of questions, such as:

• When did your symptoms start?
• Did any special events or circumstances happen before or at the same time that your symptoms developed?
• Have you received any treatment yet?
• Have your symptoms been continuous or do they come and go?
• How are your symptoms affecting your lifestyle?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do you have any other medical conditions?
• Lechien JR, et al. Management of bilateral vocal fold paralysis: A systematic review. Otolaryngology — Head and Neck Surgery. 2024; doi:10.1002/ohn.616.
• Vocal fold paralysis. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/vocal-fold-paralysis. Accessed May 18, 2022.
• Vocal fold paralysis. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/Vocal-Fold-Paralysis. Accessed May 18, 2022.
• Doherty GM, ed. Otolaryngology: Head & neck surgery. In: Current Diagnosis & Treatment: Surgery. 15th ed. McGraw Hill; 2020. https://accessmedicine.mhmedical.com. Accessed May 18, 2022.
• Bruch JM, et al. Hoarseness in adults. https://www.uptodate.com/contents/search. Accessed May 18, 2022.
• Ryu CH, et al. Guidelines for the management of unilateral vocal fold paralysis from the Korean Society of Laryngology, Phoniatrics and Logopedics. Clinical and Experimental Otorhinolaryngology. 2020; doi:10.21053/ceo.2020.00409.
• de Almeida RBS, et al. Surgical treatment applied to bilateral vocal fold paralysis in adults: Systematic review. Journal of Voice; 2023; doi:10.1016/j.jvoice.2020.11.018.
• Ekbom DC (expert opinion). Mayo Clinic. May 31, 2022.
• Rapoport SK, et al. Acute vocal cord paresis and paralysis after COVID-19 infection: A case series. Annals of Otology, Rhinology & Laryngology. 2021; doi:10.1177/00034894211047829.
• Kellerman RD, et al. Hoarseness and laryngitis. In: Conn's Current Therapy 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed April 17, 2024.
• Kurz A, et al. Selective electrical surface stimulation to support functional recovery in the early phase after unilateral acute facial nerve or vocal fold paralysis. Frontiers in Neurology. 2022; doi:10.3389/fneur.2022.869900.
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