Vocal cords vibrate to make sound. Vocal cords also close when you swallow. They protect your airway from food going into your lungs. When vocal cords do not move, they are considered paralyzed.

There are two types of VCP:

  1. Both vocal cords do not move, called bilateral vocal cord paralysis (BVCP)
  2. Only one vocal cord moves, called unilateral vocal cord paralysis (UVCP)

Even though the two are related, the causes and management for each condition are different.

Causes of BVCP

A child can be born with BVCP or it can result from another body system problem that affects vocal cord movement. It is often associated with trauma during birth and abnormalities such as Chiari malformations or increased pressure within the skull (intracranial). However, often the cause is unknown.

Additional potential causes include:

  • Delayed development of the nerves and brain centers that cause vocal cord movement
  • Trauma to the head, neck and chest
  • Illness and / or infections
  • Neck, chest or heart surgery
  • History of breathing tube placement
  • Head, neck or chest tumors

Signs and Symptoms

  • The newborn can have a high-pitched sound that worsens when the child gets upset or cries; this is called stridor.
  • Usually infants have trouble breathing, and may turn blue or have pauses in breathing.
  • The child may have frequent pneumonias because liquids and / or food go into the airway and the child is unable to cough well (also called aspiration).
  • The child may choke or cough during feedings.


If BVCP is suspected, a flexible scope with a camera is passed through the nose and throat while the child is awake. The flexible scope will give a close-up view of the vocal cords and other structures around the vocal cords. This will show whether the vocal cords move or not.

If the doctor feels there is a defect in the structure around the vocal cords, a microscopic laryngoscopy and bronchoscopy (MLB) may be needed to look at the airway below the level of the vocal cords. This is done in the operating room under anesthesia.


We take a holistic approach to assessing and diagnosing our patients. We assess all aspects of a child and individualize a treatment plan that encompasses all levels of care. Doctors in multiple disciplines work together to determine the best course of action for your child. Your child’s needs are discussed with you and your family, leading to an integrated, customized treatment plan.

Treatment for BVCP aims to ensure a safe and stable airway, preserve speech and allow safe swallowing and weight gain. Further testing may be done to find the underlying cause of the BVCP because the treatment depends on its cause.

Your physician may want to simply observe your child for up to a year because vocal cord paralysis can sometimes resolve itself without specific treatment.

If nodules or polyps are causing the BVCP, surgery may be needed to remove them from the vocal cords. Nodules are noncancerous, hard, callous-like growths on both vocal cords that are caused by repeated or long-term vocal strain or abuse. A polyp is like a nodule but larger and appears as a swelling, bump, or blister.

If swallowing or breathing difficulties are a problem, a tracheotomy may be needed to open the windpipe in order to maintain a safe and stable airway. In some cases, surgery is needed to increase the size of the opening in the back of the larynx.

Speech and language therapy may improve your child’s voice as well.

Call Your Child’s Doctor If:

If your child has difficulty breathing or his / her lips or face have a blue appearance, call 911.

Call your child’s doctor if your child struggles to swallow his / her food, coughs or chokes often when eating or is not gaining weight.

Contact Us

If you have any questions, contact the Division of Pediatric Otolaryngology / Head and Neck Surgery at Cincinnati Children’s, 513-636-4355, ent@cchmc.org.