Should Lyme Disease Be Added to the Causes of Vocal Cord Paralysis?
Lyme disease vocal cord paralysis is an uncommon but clinically important presentation. Neurologic Lyme disease can affect the nerves controlling the vocal cords, leading to hoarseness, voice changes, or even loss of voice in some patients.
In the Prevention article, doctors describe how Lyme disease can impact a person’s vocal cords. “Lyme can affect the nerves that are responsible for controlling the muscles in the vocal cords,” says Amesh A. Adalja, MD, an infectious disease specialist at Johns Hopkins Center for Health Security. “As a result, someone could technically lose their voice if they had Lyme disease.”
In fact, a case series published in the Journal of Voice identified Lyme disease as one of several causes of vocal cord paralysis, a condition that can dramatically impact patients’ lives, affecting voice, swallowing, and airway function. Identifying the underlying cause is essential to guide treatment.
Vocal cord paralysis can be caused by neurologic and inflammatory conditions, as well as infections. Infectious causes include Lyme disease, West Nile virus, varicella, herpes, Epstein-Barr, and syphilis.
Evidence Linking Lyme Disease to Vocal Cord Paralysis
The 2016 case series examined 231 Pennsylvania patients with vocal cord paralysis or paresis. The authors found that the prevalence of Lyme disease, syphilis, and myasthenia gravis was higher in these patients compared with national averages.
Five patients (2.2%) had confirmed Lyme disease based on serology. This was significantly higher than the background incidence rate of Lyme disease in Pennsylvania (0.039%).
While this does not establish causation, it supports Lyme disease as a potential and treatable contributor in selected cases.
Importantly, Lyme disease may represent an unrecognized neurologic cause of vocal cord dysfunction in some patients.
Case Reports Highlight Treatable Cause
This is not the first time Lyme disease has been associated with vocal cord paralysis.
Martínez-Balzano and colleagues describe a 90-year-old man with bilateral vocal cord paralysis and respiratory failure requiring tracheostomy. The patient tested positive for Lyme disease and was treated with intravenous ceftriaxone, resulting in complete recovery of motor and vocal function within 2 months.
Similarly, Martzolff reported two cases of vocal fold paresis secondary to neuroborreliosis, both of which improved with antibiotic treatment.
Earlier, Schroeter described a 45-year-old singer who developed hoarseness and recurrent laryngeal nerve paralysis due to Lyme disease. After doxycycline therapy, her voice returned, allowing her to speak and sing again.
These cases highlight that Lyme-related vocal cord paralysis may be reversible when recognized and treated appropriately.
Why This Diagnosis May Be Missed
Vocal cord paralysis is most commonly attributed to malignancy, surgical injury, or idiopathic causes. As a result, infectious causes like Lyme disease may be overlooked.
Additional causes include neurologic disorders such as multiple sclerosis, ALS, Parkinson disease, and myasthenia gravis, as well as inflammatory conditions including sarcoidosis and lupus.
Because Lyme disease can mimic many of these conditions, it may not be included in the initial diagnostic evaluation.
For a broader overview of symptoms that may overlap with other conditions, see Lyme disease symptoms.
Clinical Perspective
In my 37 years of clinical experience treating Lyme disease, neurologic involvement can present in unexpected ways. While vocal cord paralysis is uncommon, it reflects the broader ability of Lyme disease to affect cranial and peripheral nerves.
Testing for Lyme disease should be considered in patients with otherwise unexplained vocal cord paralysis, particularly in endemic regions or when accompanied by other compatible symptoms.
Although current evidence does not establish a definitive causal relationship, the potential for a treatable infectious cause makes this an important consideration in clinical practice.
Clinical Takeaway
Lyme disease should be included in the differential diagnosis of vocal cord paralysis in selected patients. Recognizing this possibility may lead to appropriate treatment and, in some cases, full recovery of voice function.
References:
- White M, et al. Laboratory Evaluation of Vocal Fold Paralysis and Paresis. J Voice. 2016.
- Martínez-Balzano CD, Greenberg B. Bilateral Vocal Cord Paralysis Due to Neuroborreliosis. Chest. 2014.
- Martzolff L, et al. Recurrent nerve palsy due to Lyme disease. Rev Med Interne. 2010.
- Schroeter V, et al. Paralysis of recurrent laryngeal nerve in Lyme disease. Lancet. 1988.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Eight years ago I fell ill with bilateral vocal cord paralysis and all of the major symptoms of Lyme disease. I tested 4 bands positive. I had many diagnoses including Bulbar ALS. I am just this year getting treatment after 50 doctors including Mayo Clinic. Was told it was in my head. Thankful to finally be with an excellent LLMD. My vocal cords and one diaphragm are paralyzed.
Interesting that they’ve found a tie between Lyme disease and issues with the vocal cords.
Ever since I’ve been infected with Lyme disease, my vocal quality has deteriorated at times. I used to love to sing, but lately have been frustrated with a scratchy voice which I’m sometimes unable to control like I could before Lyme.
I’ve read of other Lyme patients having chronic strep and throat pain but this hasn’t been my issue. It has been more about the vocal quality and control, which I’m assuming could be related to the vocal cords.
I also found the article helpful. You may want to contact the authors or share the blog with your ENT.
I’ve been searching for an overall review of my medical issues and found several with all the cysts in or on brain and other organs also with swollowing gag reflex issues. This will be added to my list of papers to take to my Drs. But Geisinger has also just denied one of my scripts which is for Lyme and many tests have been ignored with ” we don’t think insurance will cover” and they don’t even try to submit. Geisinger insurance too.
Suggestions?
The medical community is beginning to publish a wider range of papers covering new areas e.g. vocal cords. The issues are complex. Hopefully, other ENT specialists will look further.
Glad I found this site as I was diagnosed with late Lyme in 2007 and after years of extensive treatment, still struggling with my vocal cords. Most recently worse sounding that usual. Also lip problems with them being sore since last summer. Also had a case of strep and reactivated mono last summer. Some old Lyme symptoms creeping back into my life most recently. I’m thinking it will never go away completely.
I lost my voice completely 3 years ago. Not a good development for a musician. I have been having botox injections in my vocal cords for a year without success. I’m so glad I found this site. I was bitten by a tic 5-6 years ago and although I was treated with antibiotics at the time it would seem that there has been some lasting damage from the virus, mostly muscular.
I thought the paper on vocal cord paralysis was a good start in looking a second time at tick borne illnesses. Hopefully, my Lyme disease science blog will lead to further study. Lyme and related co-infections are often bacterial or a parasite that are amenable to treatment. It is worth a second look at tick borne problems.
My had a tick bite and passed away from bulbar ALS about 6 years later. She did not test positive, but the tests are notorious for false negative.
If had 3 surgeries on my vocal cords in the past 25 years. The doctors have said that they believe I have fibromyalgia. However I test positive for 4 of the 5 Lyme’s markers. Can a person be positive for both?
Yes. Let me know if you have additional questions.
A friend who’s got Lyme’s forwarded the article regarding the correlation between Lyme’s and vocal cord paralysis. I’ve had chronic throat infections/strep since a small child (I am 54). I’ve tested 4 out of the 5 markers for Lyme’s for years. I’ve had 4 vocal cord surgeries. The doctors have diagnosed me with fibromyalgia for 25 years now. I know that whatever damage is irreversible and I am not sure what treatment might help at this point. I would love to find a doctor nearby for a consultation. I live n at Tahoe, California. Thanks in advance for your help
I shared my understanding of the case. I have not seen other information on the subject. I have patients with fibromyalgia who turned out suffered from Lyme disease. I do not know anyone in the areas. You may find someone through portals at LymeDisease.org or ILADS.org.
My symptoms began with slurred slow speech. I then developed muscle twitching. This all started late March 2029. I went to a neurologist and he told me he believed I had motor neuron disease. I then went to an integrated medical dr that tested me for Lyme disease. I am now on my 4th week of antibiotics. It is a 22 week program. I still have muscle tremors and my voice is still weak and slower than normal. But my energy is increasing and my joint paint is getting better. I just want to know if my voice will ever be the same again. It takes on the sound of someone that has been heavily drinking when I am tired. The old me that talked fast and loud is no where to be found. Thanks.
I have seen patients in my practice with bulbar ALS with the speech pattern you are referring to. Bulbar ALS is different that vocal cord paralysis. I have treated patients with ALS for Lyme disease. Some have improved with antibiotics. Some have not.
Neurological conditions. If you have certain neurological conditions, such as multiple sclerosis or Parkinson’s disease, you may experience vocal cord paralysis.
It is important to include other specialists including a neurologist and ENT to rule out other causes.
I have chronic neurological lyme disease for many years. In the last several years l have been presenting with spasmotic dysphonia. The Dr is wanting to try botox treatment. Is this a good idea? I suffer from simple partial temporal lobe seizures at night. I did not have these until l was diagnosed with lyme. The neurologists l have seen don’t believe in Lyme. I had very high score on Armin lab tests for both European and North American strains.
I have not seen spastic dysphonia in my practice. I wrote the blog on the subject to share the author’s case. I have Lyme disease patients in my practice with more than one disease.