Laryngeal nerve damage is injury to one or both of the nerves that are attached to the voice box.

Injury to the laryngeal nerves is uncommon.

However, it may occur as a complication of neck or chest surgery (especially thyroid, lung, or heart surgery) or as a result of a breathing tube in the windpipe (endotracheal tube).

Laryngeal nerve damage may also occur from tumors in the neck or upper chest, such as thyroid or lung cancer.

The most common symptoms are hoarseness and difficulty speaking. Difficulty swallowing may also occur.

Injury to both the left and right laryngeal nerves is an urgent situation that can lead to difficulty breathing.

Laryngoscopy and bronchoscopy allow the doctor to see if the vocal cords move abnormally. Abnormal movement usually means a laryngeal nerve is injured.

An x-ray or CT scan of the chest may be done to detect any problems in the chest that might be responsible for the injury.

Treatment depends on the cause of the injury. In some instances, no treatment may be needed and the nerve may recover on its own. Voice therapy is useful in some cases.

If surgery is needed, the goal is generally to change the position of the paralyzed vocal cord to improve the voice. This can be done with:

• Injections of collagen, Gelfoam, or some other substance
• Thyroplasty
• Arytenoid adduction

If both left and right nerves are damaged, an immediate tracheotomy may be needed to allow breathing, followed by additional surgery at a later date.

The outlook depends on the cause of the injury. In some cases, the nerve rapidly returns to normal. However, sometimes the damage is permanent.

Call your health care provider if you have unexplained hoarseness that persists for more than 3 weeks or if you have difficulty breathing.