Vocal cord paralysis

Vocal cord paralysis (VCP) also occurs at a high prevalence in patients with repaired OA/TOF, with figures ranging from 3% to 20%. Whilst it is usually managed conservatively, it does aggravate dysphagia, and some TOFs never achieve a safe swallow and remain tube fed in adulthood. It also poses a risk in any future intubation as there is a heightened risk of damage to the other cord. (7,93) This is usually unilateral and can affect either vocal cord, but one study of children born with OA/TOF presenting to an ENT clinic found nearly half had bilateral immobility. However, it is likely that those referred to an ENT clinic are the most severe cases, as many go undiagnosed as their body adapts to compensate for the damage. (99)

VCP impacts voice quality, with the voice being breathy and weak, and causing dyspnoea on talking, particularly on the telephone and in noisy areas. The severity of this can be assessed using the Voice Outcome Survey. (100)

Poor voice quality has an impact on those with VCP both socially and in choice of employment. Qualitative research shows people with VCP report frustration with communication difficulties (difficulty being understood, having to repeat themselves and other peoples’ impatience) and at work due to their voice. It can also lead to social isolation as sufferers limit long conversation, talk on telephones, Bluetooth, Zoom/Discord/WebEx etc due to the added effort and strain this puts on the voice. This all can in turn lead to depression as a result of the social isolation. Work is often also an issue – those jobs that rely on the voice such as teaching, singing, call centres are unlikely to be feasible in this condition, and those with voice problems have considerably higher sickness absence in these professions. There is also a negative impact on job satisfaction and performance. Even in those professions less reliant on speech, sickness absence is higher in those with VCP. (101–103)