Right Vocal Cord Paralysis: Causes, Diagnosis, and Recovery - Otolaryngology

Right vocal cord paralysis?

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Hello Dr.
Cheng,
On January 13, 2023, I visited a regional hospital in Yunlin due to a cold and cough.
During the examination, the physician inadvertently discovered that my right vocal cord exhibited signs of paralysis using a nasal endoscope (my voice was not hoarse at the time of the examination).
The doctor suggested monitoring the situation and scheduled a follow-up appointment for six months later, on July 13, 2023.
During this follow-up, the physician again used a nasal endoscope to examine my right vocal cord and found that the paralysis had worsened (however, my voice remained similar to the previous visit, with no significant hoarseness).
The doctor then arranged for me to undergo a neck ultrasound (performed on August 1, 2023) and an upper gastrointestinal endoscopy (performed on July 31, 2023).
After the examinations, I returned to the ENT clinic on August 4, 2023, to review the reports.
The results of the two examinations were as follows:
1.
Neck ultrasound: All areas of the neck were normal (no nodules or abnormalities; the report suggested that the right vocal cord paralysis might be caused by a viral infection).
2.
Upper gastrointestinal endoscopy: The esophagus appeared normal, with mild gastroesophageal reflux and chronic mild gastritis (treated with medication prescribed by a hepatobiliary and gastrointestinal specialist).
After reviewing the reports, the physician again used a nasal endoscope to observe the condition of my right vocal cord paralysis.
Following the examination, the doctor noted slight improvement in the paralysis compared to three weeks prior (on July 13, 2023).
Initially, the doctor intended to order a chest CT scan after these two examinations, but since the previous tests showed no abnormalities and considering my right vocal cord appeared to be recovering, along with my previous chest CT report from August 2022 (which was performed due to a 3mm nodule found in my left lung during a low-dose CT scan in February 2021, and the follow-up scan in August 2022 showed that the nodule had disappeared), the ENT physician advised me to return for a follow-up on the status of my right vocal cord in three months.
However, I remained concerned about the recovery of my vocal cord, so I sought a second opinion at another teaching hospital in Taichung on September 5, 2023.
The physician examined my vocal cords using a nasal endoscope and found significant improvement in the right vocal cord paralysis.
Essentially, both vocal cords were functioning normally, but upon closer observation, there was a slight catch when the right vocal cord opened, although there were no issues with closure or opening.
I would like to ask Dr.
Cheng two questions:
1.
Based on the physician's examination, my right vocal cord paralysis seems to be gradually recovering, appearing to be about 80-90% improved.
Do I need to undergo further examinations or imaging (such as a chest CT), or is it sufficient to wait for the scheduled follow-up in three months?
2.
During my follow-up on August 4, 2023, the physician discussed that a chest CT was not necessary at this time because my right vocal cord paralysis showed signs of recovery (subsequently, on September 5, 2023, I visited the ENT department at the teaching hospital in Taichung, where the physician reviewed the endoscopic images with me, indicating that the opening and closing were generally normal, with only a slight catch during opening).
The physician also mentioned that the previous two examinations showed no abnormalities.
If the vocal cord paralysis were caused by a tumor compressing the recurrent laryngeal nerve, the tumor would likely be of significant size, and unless treated or removed, the vocal cord paralysis would not recover on its own.
In contrast, paralysis caused by a viral infection could potentially recover.
Therefore, the physician's report suggested a temporary right vocal cord paralysis likely due to a viral infection.
I would like to know if the assessment and statements made by the physician at the Yunlin regional hospital are accurate.
I appreciate your assistance in clarifying these professional concerns.
Thank you very much.

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Jerry Lin, 50~59 year old female. Ask Date: 2023/09/14