Lyme Disease Vocal Cord Paralysis: A Rare but Treatable Cause
HOARSENESS THAT WON’T GO AWAY?
VOICE CHANGES WITHOUT A CLEAR CAUSE?
COULD LYME DISEASE AFFECT THE VOCAL CORDS?
Lyme disease vocal cord paralysis is an uncommon but clinically important presentation caused by neurologic involvement of the nerves controlling the vocal cords.
“My voice changed—and no one could explain why.”
Lyme disease can affect cranial and peripheral nerves, leading to symptoms such as hoarseness, voice weakness, or even loss of voice in some patients.
“Lyme can affect the nerves that are responsible for controlling the muscles in the vocal cords,”
explains an infectious disease specialist.
“As a result, someone could technically lose their voice.”
This presentation fits within the broader spectrum of neurologic Lyme disease, where infection disrupts nerve function in unexpected ways.
Evidence Linking Lyme Disease to Vocal Cord Paralysis
A 2016 case series examined 231 patients with vocal cord paralysis or paresis in Pennsylvania.
The authors found that the prevalence of Lyme disease was higher than expected compared with national averages.
Five patients (2.2%) had confirmed Lyme disease, compared with a background incidence of 0.039%.
While this does not prove causation, it supports Lyme disease as a potential—and treatable—contributor in selected cases.
This suggests Lyme disease may represent an unrecognized neurologic cause of vocal cord dysfunction.
Case Reports Highlight a Treatable Cause
Several case reports illustrate the potential reversibility of Lyme-related vocal cord paralysis.
One report described a 90-year-old man with bilateral vocal cord paralysis and respiratory failure requiring tracheostomy.
After treatment with intravenous ceftriaxone, he experienced complete recovery of motor and vocal function within two months.
Other reports describe vocal fold paresis due to neuroborreliosis that improved with antibiotic treatment.
In another case, a 45-year-old singer developed recurrent laryngeal nerve paralysis due to Lyme disease. After doxycycline therapy, her voice returned.
These cases suggest that Lyme-related vocal cord paralysis may be reversible when recognized early.
Why This Diagnosis May Be Missed
Vocal cord paralysis is most often attributed to malignancy, surgical injury, or idiopathic causes.
As a result, infectious causes such as Lyme disease may not be considered initially.
Other possible diagnoses include neurologic disorders such as multiple sclerosis, ALS, Parkinson disease, and myasthenia gravis, as well as inflammatory conditions like sarcoidosis and lupus.
Because Lyme disease can mimic many of these conditions, it may not be included in the initial evaluation—contributing to
delayed diagnosis.
When to Consider Lyme Disease
Lyme disease should be considered in patients with vocal cord paralysis when:
- No clear structural cause is identified
- Symptoms occur alongside neurologic complaints
- There is possible tick exposure or residence in an endemic area
For a broader overview, see Lyme disease symptoms.
Clinical Perspective
Neurologic Lyme disease can present in unexpected ways, reflecting its ability to affect cranial and peripheral nerves.
Although vocal cord paralysis is uncommon, recognizing a potential infectious cause is important—especially when the condition may be reversible.
Testing for Lyme disease may be appropriate in selected cases where other causes have not been identified.
Clinical Takeaway
Lyme disease should be included in the differential diagnosis of vocal cord paralysis in selected patients.
Identifying a treatable infectious cause may lead to recovery of voice function in some cases.
Frequently Asked Questions
Can Lyme disease cause vocal cord paralysis?
Yes. Lyme disease can affect the nerves controlling the vocal cords, leading to paralysis or weakness.
Is this condition reversible?
Some cases improve with antibiotic treatment, particularly when diagnosed early.
Why is it often missed?
More common causes such as cancer or surgical injury are typically considered first.
When should Lyme disease be considered?
When vocal cord paralysis occurs without a clear cause, especially with neurologic symptoms or tick exposure.
References:
- White M, et al. Laboratory Evaluation of Vocal Fold Paralysis. J Voice. 2016.
- Martínez-Balzano CD, Greenberg B. Chest. 2014.
- Martzolff L, et al. Rev Med Interne. 2010.
- Schroeter V, et al. 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.