Paralyzed Vocal Cords – Was It Medical Malpractice?

Vocal Cord Paralysis

Vocal cord paralysis is a serious condition that can profoundly impact a person’s ability to speak and breathe. While it is often the result of surgical errors, it can also be caused by other forms of medical malpractice, including improper intubation, delayed diagnosis of nerve damage, or adverse effects from certain medications. In some cases, medical providers fail to recognize or address complications that lead to permanent vocal cord impairment.

Understanding the surgical procedures and medical treatments that may inadvertently cause vocal cord damage, the medical mistakes leading to such paralysis, preventive measures, and the legal implications is crucial for patients and their families.

Surgical Causes of Paralyzed Vocal Cords

Many surgical procedures pose a risk to the vocal cords, particularly when they involve structures near the larynx or the recurrent laryngeal nerve (RLN), which controls vocal cord movement.

Thyroid Surgery (Thyroidectomy)

• Risk: The RLN runs near the thyroid gland. Injury during thyroid removal can cause unilateral or bilateral vocal cord paralysis.
• Mechanism: Direct trauma, stretching, or accidental cutting of the RLN during surgery can result in vocal cord dysfunction.

Neck Surgery (Cervical Spine Surgery, Lymph Node Removal)

• Risk: Surgeries in the cervical spine or lymph nodes can put the RLN or the vagus nerve at risk.
• Mechanism: Nerve trauma during dissection or hardware placement (e.g., in anterior cervical spine surgeries) can impair vocal cord function.

Chest Surgery (Cardiothoracic Surgery, Aortic Aneurysm Repair)

• Risk: The left RLN loops around the aortic arch; cardiac surgeries can stretch or injure it.
• Mechanism: Retraction, ischemia, or direct injury during cardiac procedures can lead to vocal cord paralysis.

Carotid Endarterectomy

• Risk: Carotid artery surgery is performed near the vagus nerve.
• Mechanism: Manipulation or damage to the vagus nerve can affect vocal cord innervation.

Esophageal Surgery

• Risk: Proximity of the esophagus to the RLN makes it vulnerable during esophagectomy or fundoplication.
• Mechanism: Nerve injury during dissection or repair can impair vocal cord movement.

Intubation and Anesthesia

• Risk: Endotracheal intubation during general anesthesia can injure the vocal cords.
• Mechanism: Prolonged intubation, improper tube placement, or forceful intubation can cause vocal cord damage, edema, or granulomas. 

Medical Treatments and Devices that can injure the Vocal Cords

Certain treatments and medical devices intended to manage serious health conditions can also inadvertently damage the vocal cords. Therapies such as radiation and procedures like tracheostomy, while often necessary for treating life-threatening illnesses, carry risks that can impact vocal cord function. In some cases, these treatments cause direct trauma, while in others, long-term effects such as scarring, fibrosis, or nerve damage gradually impair vocal cord mobility. While some complications may be unavoidable, medical negligence—such as improper technique, inadequate monitoring, or failure to prevent known risks—can lead to unnecessary vocal cord injury and long-term disability.

Radiation Therapy (Head and Neck Cancer)

• Risk: Radiation used to treat cancers of the head, neck, or chest can damage the larynx and nerves.
• Mechanism: Radiation can cause fibrosis, nerve damage, or scarring of the vocal cords, leading to reduced mobility or paralysis.

Tracheostomy

• Risk: A surgical airway created through the trachea can damage the larynx and vocal cords.
• Mechanism: Poor surgical technique, prolonged mechanical ventilation, or tube misplacement can injure the vocal cords.

Medications that can cause Vocal Cord Paralysis

Some medications have direct or indirect effects on the vocal cords, potentially leading to voice changes, weakness, or even paralysis. Certain drugs can interfere with nerve function, muscle control, or the structural integrity of the vocal cords, sometimes as an unintended side effect of treatment. While these complications may be unavoidable in some cases, medical negligence—such as improper medication management, failure to monitor for adverse effects, or incorrect dosing—can contribute to unnecessary harm. Patients receiving anesthesia, inhaled steroids, or chemotherapy should be carefully monitored to prevent and promptly address medication-induced vocal cord dysfunction.

Neuromuscular Blocking Agents

• Risk: Used during anesthesia, these agents can cause temporary vocal cord paralysis if not properly reversed.
• Mechanism: Persistent neuromuscular blockade after surgery can leave vocal cords immobile.

Inhaled Corticosteroids

• Risk: Long-term use for asthma or COPD can affect the vocal cords.
• Mechanism: Steroids can cause local immunosuppression, leading to fungal infections (e.g., Candida), vocal cord atrophy, or muscle weakness.

Chemotherapy

• Risk: Some chemotherapy agents, such as vinca alkaloids, can cause peripheral neuropathy.
• Mechanism: Neuropathy affecting the vagus nerve or RLN can impair vocal cord function.

Traumatic Causes of Damaged Vocal Cords in Medical Settings

Trauma during medical interventions can also damage the vocal cords, leading to temporary or permanent voice and breathing difficulties. Various procedures that require the insertion of medical instruments through or near the vocal cords pose a risk of direct injury, nerve damage, or prolonged pressure effects. Even when performed correctly, these interventions can sometimes cause unforeseen complications that impact vocal cord function. However, when negligence—such as improper technique, lack of careful monitoring, or failure to address complications—occurs, patients may suffer needless serious and avoidable harm.

Bronchoscopy or Endoscopy

• Risk: These procedures involve passing instruments through the vocal cords.
• Mechanism: Direct trauma or prolonged pressure can damage the cords.

Nasogastric Tube Placement

• Risk: Inserting a tube through the nasal passage and throat can affect the larynx.
• Mechanism: Misplacement or prolonged presence can cause pressure injuries or nerve damage.

Rare but Possible Causes of Vocal Cord Paralysis

Certain rare medical scenarios can also result in vocal cord damage, even in the absence of direct trauma or surgical error. Neurological conditions, such as strokes or brainstem tumors, can interfere with the nerve pathways that control vocal cord movement, leading to paralysis or weakness. Additionally, medical treatments intended to manage voice disorders, such as Botox injections, carry risks if improperly administered. While these situations may not always be the result of negligence, errors in diagnosis, treatment planning, or procedure execution can exacerbate vocal cord dysfunction and contribute to long-term impairment.

Central Nervous System Lesions

• Risk: Strokes, brainstem tumors, or multiple sclerosis can affect the vagus nerve nuclei.
• Mechanism: Disruption of central control can lead to vocal cord paralysis.

Botox Injections

• Risk: Used for spasmodic dysphonia, Botox injections into the vocal cords can sometimes cause temporary paralysis.
• Mechanism: Over-injection or improper placement can cause prolonged vocal cord immobility.

Preventing Damage To The Vocal Chords During Surgical Procedures And Medical Interventions

Medical professionals can take several critical steps to reduce the risk of vocal cord damage during surgical procedures and other medical interventions.

• Surgeons should use intraoperative nerve monitoring, particularly in procedures near the recurrent laryngeal nerve, to help identify and protect delicate structures that control vocal cord function.
• Anesthesiologists must ensure proper endotracheal tube placement and avoid excessive pressure on the vocal cords during intubation. When performing procedures such as bronchoscopy, endoscopy, or nasogastric tube placement, clinicians should use careful technique to minimize trauma.
• In cases where radiation therapy is necessary, oncologists should take steps to limit exposure to the larynx and surrounding nerves.
• Additionally, healthcare providers prescribing medications known to affect nerve or muscle function, such as neuromuscular blocking agents or chemotherapy drugs, should closely monitor patients for early signs of vocal cord dysfunction.
• Proper training, adherence to evidence-based protocols, and vigilant post-procedure monitoring are essential to preventing avoidable vocal cord injuries and ensuring patient safety.

When Is Vocal Cord Paralysis Due To Medical Malpractice?

Damage to the vocal cords may be considered medical malpractice or negligence when it results from a healthcare provider’s failure to follow accepted medical standards. This can occur during surgery if a surgeon carelessly damages the recurrent laryngeal nerve, fails to use intraoperative nerve monitoring in high-risk procedures, or does not recognize and address nerve injury before completing the operation. Anesthesiologists may be negligent if they improperly place an endotracheal tube, apply excessive pressure during intubation, or fail to monitor for post-extubation complications.

Medical negligence can also arise from improper medication management, such as prescribing drugs that affect nerve function without appropriate monitoring. Additionally, radiation oncologists who fail to shield the larynx or miscalculate dosage may cause preventable vocal cord damage. If a patient’s vocal cord paralysis or injury results from avoidable errors, lack of proper technique, or failure to take reasonable precautions, the responsible medical provider may be held liable for malpractice.

Medical Malpractice Case Examples Involving Paralyzed Vocal Cords

Several medical malpractice lawsuits have resulted in settlements or jury verdicts in favor of plaintiffs who suffered vocal cord damage:

• West Virginia Case: A 41-year-old woman underwent a thyroidectomy during which the surgeon allegedly failed to protect her laryngeal nerve, leading to permanent vocal cord paralysis and necessitating a permanent tracheotomy. The jury awarded her $5,788,977.36.
• New York Settlement: A 51-year-old man underwent parathyroid surgery, during which the surgeon negligently transected his recurrent laryngeal nerve, resulting in permanent left vocal cord paralysis. The case was settled for $750,000.
• Middlesex County Verdict: A patient underwent unnecessary thyroid surgery, leading to complications including vocal cord paralysis. The jury awarded the plaintiff over $1.2 million in damages.
• Virginia Case: A patient suffered bilateral recurrent laryngeal nerve injury and became dependent on a tracheostomy after a total thyroidectomy in which both recurrent laryngeal nerves were severed. The jury awarded $2.2 million to the plaintiff.

These cases highlight the severe consequences of medical negligence leading to vocal cord damage and underscore the legal recourse available to affected patients.

Legal Considerations in Pennsylvania

In Pennsylvania, the statute of limitations for medical malpractice claims is generally two years from the date the injury was discovered or reasonably should have been discovered. It’s imperative to consult with legal counsel promptly to ensure compliance with these time constraints.

At Lupetin & Unatin, we understand the devastating impact that surgical errors leading to vocal cord paralysis can have on patients and their families. Our firm operates on a contingency fee basis, meaning we only receive payment if we successfully secure compensation for you. With extensive experience handling cases involving surgical errors and vocal cord injuries, we are committed to advocating for victims of medical malpractice to obtain the justice and compensation they deserve.