speech therapy exercises for vocal cords

Paralyzed Vocal Cord Exercises

Ken Tamplin, Professional Vocal coach

Reviewed by Editorial Team

Updated on December 18, 2023

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Table of Contents

Improved speech clarity.

Paralyzed vocal cords can significantly impact speech clarity, making it difficult to communicate effectively. However, incorporating specific exercises into your routine can help improve speech clarity. One effective exercise is straw phonation. This involves making sounds while exhaling through a straw, which helps to strengthen the vocal cords and improve their coordination. Another beneficial exercise is vocal cord adduction exercises, which involve practicing making sounds by bringing the vocal cords together. These exercises can help to enhance the strength and coordination of the vocal cords, leading to improved speech clarity over time.

Straw Phonation Exercise

Straw phonation is a widely used exercise to improve speech clarity in individuals with paralyzed vocal cords. To perform this exercise, you will need a straw. Begin by taking a deep breath and exhaling gently through the straw while making a continuous “humming” sound. This exercise helps to provide resistance to the airflow, promoting better closure and coordination of the vocal cords.

Vocal Cord Adduction Exercises

Vocal cord adduction exercises involve practicing making sounds that require bringing the vocal cords together, such as saying “ee” or “oo.” These exercises aim to train the vocal cords to come together effectively, which is essential for improved speech clarity.

Enhanced Swallowing Function

Paralyzed vocal cords can also impact swallowing function, leading to difficulties in eating and drinking. However, specific exercises can help enhance swallowing function and reduce the risk of aspiration. One effective exercise is the Mendelsohn maneuver, which involves swallowing and holding the throat muscles in a raised position for a few seconds. This exercise helps to strengthen the muscles involved in swallowing, leading to improved swallowing function over time.

Mendelsohn Maneuver

To perform the Mendelsohn maneuver, start by swallowing while focusing on the upward movement of your throat muscles. Hold your throat muscles in the raised position for a few seconds before relaxing. Practicing this maneuver regularly can help strengthen the muscles involved in swallowing, leading to enhanced swallowing function.

Psychological Benefits of Vocal Cord Exercise

Engaging in vocal cord exercises not only offers physical benefits but also provides psychological advantages. Individuals with paralyzed vocal cords often experience frustration and a sense of loss due to communication difficulties. By actively participating in vocal cord exercises, individuals can regain a sense of control over their voice and communication abilities. Additionally, as speech clarity and swallowing function improve, individuals may experience a boost in confidence and overall well-being.

Practical Tips and Advice

Setting realistic goals for vocal cord rehabilitation.

When embarking on vocal cord rehabilitation, it is essential to set realistic goals to track progress effectively. Speak with a speech-language pathologist to gain insights into what to expect and how to set achievable milestones. Setting realistic goals can help maintain motivation and provide a clear path toward vocal cord rehabilitation.

Tracking Progress and Adapting Exercise Regimen

Tracking progress is crucial in vocal cord rehabilitation. Keep a journal to document improvements in speech clarity and swallowing function. Additionally, be open to adapting your exercise regimen based on your progress. Consult with your speech-language pathologist to make necessary adjustments to your exercises and techniques as you progress through rehabilitation.

Integrating Vocal Therapy Techniques into Daily Activities

To maximize the benefits of vocal cord exercises, consider integrating vocal therapy techniques into your daily activities. Practice speaking exercises during conversations with friends and family, and incorporate swallowing exercises with meals. By integrating these exercises into daily activities, you can make consistent progress in vocal cord rehabilitation.

In conclusion, engaging in paralyzed vocal cord exercises can significantly improve speech clarity, enhance swallowing function, and provide psychological benefits. Incorporating exercises such as straw phonation, vocal cord adduction exercises, and the Mendelsohn maneuver can lead to positive outcomes in vocal cord rehabilitation. By setting realistic goals, tracking progress, and integrating vocal therapy techniques into daily activities, individuals can effectively work towards improving their vocal cord function and overall quality of life.

1. How often should I perform vocal cord exercises?

It is recommended to perform vocal cord exercises as advised by your speech-language pathologist. Typically, exercises may be performed daily or as per a specific schedule tailored to your rehabilitation plan.

2. Can vocal cord exercises completely restore vocal cord function?

While vocal cord exercises can lead to significant improvements in vocal cord function, the extent of restoration varies among individuals. Consistency and adherence to the recommended exercises play a crucial role in achieving positive outcomes.

3. Are there any dietary restrictions during vocal cord rehabilitation?

Your speech-language pathologist may provide specific dietary recommendations based on your swallowing function. It’s essential to follow any dietary guidelines provided to support your vocal cord rehabilitation.

4. Can vocal cord exercises help with breath control during speech?

Yes, vocal cord exercises can contribute to improved breath control during speech by strengthening the muscles involved in vocalization. As speech clarity improves, individuals may also notice enhanced breath control.

5. How long does it take to see improvements from vocal cord exercises?

The timeline for seeing improvements from vocal cord exercises varies for each individual. Some may notice improvements within a few weeks, while others may require a longer duration. Consistent practice and adherence to the exercise regimen can contribute to positive outcomes over time.

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• Vocal cord paralysis

Your health care provider likely asks about your symptoms and lifestyle, listens to your voice, and asks you how long you've had voice problems. To further evaluate your voice problems, the following tests may be performed:

Laryngoscopy. Your health care provider looks at your vocal cords using a mirror or a thin, flexible tube (known as a laryngoscope or endoscope) or both. You may also have a test called videostrobolaryngoscopy. It uses a special scope that contains a tiny camera at its tip or a larger camera connected to the scope's viewing piece.

These special high-magnification endoscopes allow your care provider to view your vocal cords directly or on a video monitor to determine the movement and position of the vocal cords and whether one or both vocal cords are affected.

Laryngeal electromyography. This test measures the electrical currents in your voice box muscles. To do this, the health care provider typically inserts small needles into the vocal cord muscles through the skin of the neck.

This test isn't used to guide treatment, but it may give your provider information about how well you may recover. This test is most useful when it's done between six weeks and six months after your symptoms began.

• Blood tests and scans. Because a number of diseases may cause nerve injuries, you may need additional tests to identify the cause of the paralysis. Tests may include blood work, X-rays, MRI or CT scans.

More Information

• Electromyography (EMG)
• Upper endoscopy

Treatment of vocal cord paralysis depends on the cause, the severity of symptoms and the time from the onset of symptoms. Treatment may include voice therapy, bulk injections, surgery or a combination of treatments.

In some instances, you may get better without surgical treatment. For this reason, your health care provider may delay permanent surgery for at least a year from the beginning of your vocal cord paralysis.

However, surgical treatment with various bulk injections is often done within the first three months of voice loss.

During the waiting period for surgery, your provider may suggest voice therapy to help keep you from using your voice improperly while the nerves heal.

Voice therapy

Voice therapy sessions involve exercises or other activities to strengthen your vocal cords, improve breath control during speech, prevent tension in other muscles around the paralyzed vocal cord or cords, and protect your airway during swallowing. Occasionally, voice therapy may be the only treatment you need if your vocal cords were paralyzed in a location that doesn't require additional bulk or repositioning.

If your vocal cord paralysis symptoms don't fully recover on their own, surgical treatments may be offered to improve your ability to speak and to swallow.

Surgical options include:

• Bulk injection. Paralysis of the nerve to your vocal cord will probably leave the vocal cord muscle thin and weak. To add bulk to a paralyzed vocal cord, a doctor who specializes in disorders of the larynx (laryngologist) may inject your vocal cord with a substance such as body fat, collagen or another approved filler substance. This added bulk brings the affected vocal cord closer to the middle of your voice box so that the opposite functioning and moving vocal cord can make closer contact with the paralyzed cord when you speak, swallow or cough.
• Structural implants. Instead of using a bulk injection, this procedure — known as thyroplasty, medialization laryngoplasty or laryngeal framework surgery — relies on the use of an implant in the larynx to reposition the vocal cord. Rarely, people who have this surgery may need to have a second surgery to reposition the implant.
• Vocal cord repositioning. In this procedure, a surgeon moves a window of your own tissue from the outside of your voice box inward, pushing the paralyzed vocal cord toward the middle of your voice box. This allows your unimpaired vocal cord to better vibrate against its paralyzed partner.
• Replacing the damaged nerve (reinnervation). In this surgery, a healthy nerve is moved from a different area of the neck to replace the damaged vocal cord. It can take as long as 6 to 9 months before your voice gets better. Some health care providers combine this surgery with a bulk injection.

Tracheotomy. If both of your vocal cords are paralyzed and positioned closely together, your airflow will be decreased. This causes a lot of trouble breathing and requires a surgery called a tracheotomy.

In a tracheotomy, an incision is made in the front of your neck to create an opening in the windpipe (trachea). A breathing tube is inserted, allowing air to bypass the vocal cords.

Emerging treatments

Linking the vocal cords to another source of electrical stimulation — perhaps a nerve from another part of the body or a device similar to a cardiac pacemaker — may restore opening and closing of the vocal cords that can't move. Researchers continue to study this and other options.

Coping and support

Vocal cord paralysis can be frustrating and affect your daily life. It can be hard to communicate with other people. A speech therapist can help you develop the skills you need to communicate.

Even if you're not able to get back the voice you once had, voice therapy can help you learn effective ways to make up for it. In addition, a speech-language pathologist can teach you how to use your voice without causing further damage to the vocal cords.

Preparing for your appointment

You're likely to first see your primary care provider unless both vocal cords are paralyzed. In that case, you'll probably first be seen in a hospital emergency department.

After the initial assessment, you'll likely be referred to a doctor who specializes in ear, nose and throat disorders. You may also be referred to a speech-language pathologist for voice assessment and therapy.

It's helpful to arrive well prepared for your appointment. Here's some information to help you get ready and what to expect from your care provider.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent illnesses or life changes.
• Make a list of all medications, vitamins or supplements that you're taking, including the dose of each.
• Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who is with you may remember something that you missed or forgot.
• Write down questions to ask your provider.

Your time with your health care provider may be limited. Preparing a list of questions can help you make the most of your time together. For vocal cord paralysis, some basic questions to ask your provider include:

• What's the most likely cause of my vocal cord paralysis?
• What kinds of tests do I need? Do these tests require any special preparation?
• Is this condition temporary, or will my vocal cords always be paralyzed?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the treatment that you're suggesting?
• Are there any restrictions on using my voice after treatment? If so, for how long?
• Will I be able to talk or sing after treatment?
• Are there any brochures or other printed material that I can take home with me?

In addition to the questions that you've prepared to ask, don't hesitate to ask any additional questions that occur to you during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, such as:

• When did your symptoms start?
• Did any special events or circumstances happen before or at the same time that your symptoms developed?
• Have you received any treatment yet?
• Have your symptoms been continuous or do they come and go?
• How are your symptoms affecting your lifestyle?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do you have any other medical conditions?
• Dankbaar JW, et al. Vocal cord paralysis: Anatomy, imaging and pathology. Insights in Imaging. 2014; doi:10.1007/s13244-014-0364-y.
• Vocal fold paralysis. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/vocal-fold-paralysis. Accessed May 18, 2022.
• Vocal fold paralysis. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/Vocal-Fold-Paralysis. Accessed May 18, 2022.
• Doherty GM, ed. Otolaryngology: Head & neck surgery. In: Current Diagnosis & Treatment: Surgery. 15th ed. McGraw Hill; 2020. https://accessmedicine.mhmedical.com. Accessed May 18, 2022.
• Bruch JM, et al. Hoarseness in adults. https://www.uptodate.com/contents/search. Accessed May 18, 2022.
• Ryu CH, et al. Guidelines for the management of unilateral vocal fold paralysis from the Korean Society of Laryngology, Phoniatrics and Logopedics. Clinical and Experimental Otorhinolaryngology. 2020; doi:10.21053/ceo.2020.00409.
• Toutounchi SJS, et al. Vocal cord paralysis and its etiologies: A prospective study. Journal of Cardiovascular and Thoracic Research. 2014; doi:10.5681/jcvtr.2014.009.
• Ekbom DC (expert opinion). Mayo Clinic. May 31, 2022.
• Rapoport SK, et al. Acute vocal cord paresis and paralysis after COVID-19 infection: A case series. Annals of Otology, Rhinology & Laryngology. 2021; doi:10.1177/00034894211047829.
• How speech occurs
• Vocal cords open and closed

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Vocal Cord Dysfunction (VCD)

Paradoxical vocal fold movement (pvfm).

Our voice specialists use the latest diagnostic tests along with their years of experience to determine whether you have vocal cord dysfunction (VCD), also known as paradoxical vocal fold movement (PVFM). Specially trained speech-language pathologists help you understand the common triggers for VCD episodes and teach you breathing exercises to help relax the throat and ease your symptoms.

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About Vocal Cord Dysfunction

VCD, a type of irritable larynx syndrome , is an upper airway disorder related to irritation of the voice box. Normal breathing requires the vocal cords to remain open so air can pass in and out of the lungs. During a VCD episode, the vocal cords start to close involuntarily during inhalation. Since your airway is narrowed, you may feel like you can’t inhale. Sometimes, sounds may come from your throat during an episode. VCD is frequently misunderstood, misdiagnosed, and mistaken for asthma or a severe allergic reaction because of similar symptoms.

Duke Voice Care has locations in Durham and Raleigh. Find one near you.

Speech Therapy for Vocal Cord Dysfunction

Speech therapy is the primary treatment for VCD. Specially trained speech-language pathologists teach you exercises designed to relieve episodes of VCD. You will learn relaxed-throat breathing and lower-abdominal breathing strategies to manage episodes of breathing difficulty. These simple techniques keep the upper airway and voice box relaxed and open for easier breathing. Your speech-language pathologist will also work with you to understand your VCD triggers and control your response to these triggers. If you are an athlete with VCD, we'll coordinate with your coaches as appropriate to provide education about the condition and promote breathing strategies for you in your sport(s).

• Voice Therapy

For many, VCD can cause throat strain during and after episodes. If this occurs, the voice itself can become strained or hoarse. A speech-language pathologist will guide you through vocal exercises to improve breathing, reduce throat strain, and find your optimal pitch and volume for strong, healthy speaking. Improving your voice will not only help you speak more easily and clearly, but it can reduce your throat irritation and shortness of breath.

Our team will take a detailed history of your breathing symptoms to note the patterns that suggest VCD and identify any triggers for these episodes. Your laryngologist -- an ear, nose, and throat (ENT) doctor with advanced training in voice and throat disorders -- will also evaluate whether any medical conditions, surgeries, or recent illnesses could have caused changes in your voice or breathing. We will perform a head and neck examination and a visual examination of your voice box.

Videolaryngostroboscopy

This detailed visual examination of your voice box helps us evaluate how your vocal cords open, close, and vibrate while you breathe and speak or sing. A tiny camera attached to a small tube called an endoscope is inserted through your nose and into your throat, which allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow-motion video images of your vocal cords. The exam takes about two minutes, and your nose can be sprayed with topical anesthetic for comfort.

Your team will look for lesions, stiffness, paralysis, irregular movements, throat strain, or incomplete closure of the vocal cords. If VCD is suspected, your team will evaluate the movement of your vocal cords during breathing. Actual episodes of VCD are rarely seen on these exams, but your voice box will be evaluated to make sure that all the structures are normal. After the exam, your team will review the images with you to discuss your diagnosis and treatment plan. Videolaryngostroboscopy is essential to reaching an accurate diagnosis and determining the best treatment for VCD and other voice box problems.

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

Why Choose Duke

Team of Experts At Duke, one of the few comprehensive voice centers in the Southeast, your care team will include laryngologists and speech-language pathologists specially trained to evaluate and treat patients with voice problems and laryngeal disorders. Our team has years of experience treating VCD.

Team Care Approach If you have other medical conditions that may contribute to your voice issues -- such as allergies, asthma, or acid reflux -- we will work with your other providers throughout Duke Health to ensure you receive the best care from an integrated team.

Care for Athletes If you are an athlete with VCD, we'll coordinate with your coach as appropriate to provide education about your disorder and promote breathing strategies for you in your sport.

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• Voice Evaluation
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Section 7 - Exercises for vocal fold paralysis

Some people can experience paralysis of the vocal cords where one or both cords do not move properly. This leads to poor function of the vocal cords meaning they do not come together to close properly to achieve normal voice production. In the links on the right, there are exercises to help achieve this closure. Please follow directions from your Speech and Language Therapist to the exercises which are best for you.

Related Links

• Watch a short film clip on Glottal onset - Voice exercise
• Watch a short film clip on Smooth onset - Voice exercise
• Watch a short film clip on Plosive consonant closure - Voice exercise
• Watch a short film clip on Pops - Voice exercise
• Watch a short film clip on Hmmm - Voice exercise
• Watch a short film clip on Glides - Voice exercise
• Watch a short film clip on Accent method - Voice exercise
• Watch a short film clip on Vocal Function Exercises - Voice exercise
• Watch a short film clip on Creak - Voice exercise
• Watch a short film clip on Sob - Voice exercise

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VOCAL CORD DYSFUNCTION (VCD) (PVFM)

What is exercise-induced laryngeal obstruction (eilo).

Exercise-Induced Laryngeal Obstruction (EILO) is commonly referred as Vocal Cord Dysfunction (VCD). It is a voice disorder where the vocal folds (cords) close when they’re supposed to be open.

A typical profile of an EILO patient reflects someone who is between the ages of 11-18 (girls more than boys), is highly competitive/successful in sports, and sets high academic and/or performance standards. EILO symptoms may transfer to non-athletic activities, when stressed.

Some patients are misdiagnosed with exercise induced asthma (EIA) instead of EILO and, subsequently, do not report any relief from steroids/inhalers. However, some patients have EILO alone or in combination with asthma, reflux, and/or allergies, and do require medical management of these symptoms as well.

Some of the signs of EILO are:

• Wheezing or other respiratory noises.
• A feeling of not inhaling enough air when playing sports (soccer, lacrosse, track, swimming, and etc.) then a quick recovery time (3-5 min).
• The need to take frequent breaks during the game (“sub-out” during soccer, lacrosse, etc.)
• Asthma or allergy medications don’t significantly help with the breathing problem.
• A history or symptoms of acid reflux.
• Points to the throat more than the chest to indicate the area of difficult breathing or tension.

How do we help?

We help athletes achieve their maximum potential by helping them participate in sports without suffering from breathing difficulties caused by the improper closing of the vocal folds.

We provide EILO patients high quality therapy techniques for managing their breath control to help them participate fully in their recreational and athletic areas of interest.

Vocal Cord Dysfunction

The vocal cords are muscles within the larynx, also called the voice box. When we breathe, they open & close involuntarily, meaning no direct action is required from the person to actively make them open or close. When talking, we choose the sounds to make, but the vocal cords respond with little active thought from us. These structures are located at the top of your breathing tube known as your trachea.

As we breathe, air passes through the vocal cords on its way to the trachea and downward to the lungs. The process is reversed as we exhale. The cords should be relaxed and open as we breathe in. If the cords tighten when we breathe in, the person may report difficulty breathing ranging from mild shortness of breathe to severe spasms of choking and inability to breathe. This out of sequence closing is known as Vocal Cord Dysfunction or VCD. Other names for this condition are Irritable Laryngeal Syndrome or Laryngospasm.

Symptoms of VCD may be:

• Anxiousness
• Frequent clearing of the throat
• Sensation of not being able to get a breath
• Tightness of the upper chest or throat
• Noisy breathing, stridor, whistling of the air when breathing in

Some of the triggers for VCD are the same as the triggers for asthma, some are different.

• Post Nasal Drip
• Psychosocial issues
• Stress / Anxiety
• Cough from irritants or viral illness
• Activities of voice strain – singing, excessive talking, yelling

VCD is three times more common in females than males. It can mimic or look like asthma to someone unfamiliar with the condition. In some people, VCD can trigger their asthma. Some people with VCD do not have asthma. Asthma symptoms usually increase over a few hours, days, or weeks and respond to medications that open the airway and reduce the inflammation. VCD symptoms usually occur or decrease suddenly and do not respond well to traditional asthma treatments. The moisture and patterned breathing associated with the SVN machine may help VCD. Often the person with VCD will experience voice changes, like hoarseness, and prolonged coughing episodes.

The best treatment for VCD is speech therapy with specific voice & breathing exercises. It is important to rest the voice, drink fluids, encourage salivation with lozenges or gum, reduce exposure to triggers when possible, and reduce stress. Keep a list of what you are doing when the VCD occurs. Listed below are two exercises that our clinic teaches to help patients relax the vocal cords.

PAUSED BREATHING:

• Sit in a position that allows your neck & shoulders to relax but keep your back straight.
• Breathe in gently through the nose.
• Stick your tongue out of your mouth, past the teeth & lower lip, in preparation to exhale. This forward stretch of the tongue helps to open the airway at the vocal cords. This may be difficult to do with a severe spasm but will be easier the more you repeat this exercise.
• With the tongue out, exhale only through the mouth in slow, paused or spaced breaths. The timing should be like saying Ha, Ha, Ha, Ha, very slowly. Don’t use your voice, just breathe out.
• Repeat 10 times and practice 3 times a day so you will know how to do it well when VCD occurs.

BELLY BREATHING:

• Sit in a position that allows your neck and shoulders to relax but keep your back straight.
• Place your hand on your belly. Breathe in gently through the nose with your belly pushing your hand outward from your body.
• As you start to exhale, place the tip of your tongue where your upper teeth meet the roof of your mouth. This will allow you to make a hissing or “S” sound as you exhale. This creates a back pressure to help keep the airway open.
• Slowly exhale allowing the hand & belly to move inward to a resting position and make the hissing or “S” sound as you push the air between your tongue & teeth.
• Repeat 10 times & practice 3 times a day so you will know how to do it well when VCD occurs.

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