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CC BY 4.0 · Int Arch Otorhinolaryngol 2025; 29(02): s00451808244
DOI: 10.1055/s-0045-1808244
Systematic Review

Vocal Cord Paralysis after Tracheal Intubation: An Overview of the Etiology and Associated Risk Factors

Meerab Anwar
1   Department of Biotechnology, Faculty of Sciences, University of Sialkot, Sialkot, Punjab, Pakistan
,
Komal Ashiq Hussain
1   Department of Biotechnology, Faculty of Sciences, University of Sialkot, Sialkot, Punjab, Pakistan
,
Pervez Anwar 
2   Department of Biochemistry, Faculty of Sciences, University of Sialkot, Sialkot, Punjab, Pakistan
› Author Affiliations
Funding The authors declare that they did not receive funding from agencies in the public, private, or non-profit sectors to conduct the present study.
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Abstract

Introduction

Vocal cord paralysis (VCP) is a deprivation of motility and the dysfunction of the vocal cords due to a defect in the vagal nerve or recurrent laryngeal nerve (RLN). It also occurs due to mutilation in the cricoarytenoid joint or posterior commissure scarring after prolonged tracheal intubation. It is a disorder with an extensive range of etiologies reliant on its laterality pattern.

Objective

To discuss the laterality pattern of VCP due to endotracheal intubation and its respective treatments, the associated etiologies, and the risk factors, to provide a new direction to physicians for its treatment and to avoid its occurrence.

Data Synthesis

We conducted a peer review of many of the articles published to date on VCP. An analysis of 967 patients from 5 studies determined that unilateral VCP (UVCP) is three times more frequent than bilateral VCP (BVCP). Furthermore, we analyzed 2,232 patients from 6 different studies that concluded surgery was the most common cause, followed by neoplastic diseases or malignancies. Another important though highly uncommon etiology of VCP is endotracheal intubation; however, it is disturbing for doctors as endotracheal intubation is a common procedure for general anesthesia.

Conclusion

A variety of factors may cause VCP, including age, comorbidities, body mass index BMI, the duration of the intubation, the handling of the apparatus, operative time, and tracheal tube sizes. Preventive measures should be prioritized to avoid severe consequences, and intubation must be performed carefully in elderly people and in subjects with lower BMIs. Knowledge of the risk factors will help physicians customize intubation procedures in the future.

Keywords

vocal cord - etiology - idiopathic - intubation - comorbidities


Publication History

Received: 29 July 2023

Accepted: 11 March 2025

Article published online:
07 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Meerab Anwar, Komal Ashiq Hussain, Pervez Anwar. Vocal Cord Paralysis after Tracheal Intubation: An Overview of the Etiology and Associated Risk Factors. Int Arch Otorhinolaryngol 2025; 29: s00451808244.
DOI: 10.1055/s-0045-1808244