Lyme Disease Vocal Cord Paralysis: A Rare but Treatable Cause
Lyme disease can affect nerves controlling the vocal cords.
Hoarseness, voice loss, and swallowing difficulty may occur in neurologic Lyme disease.
Early recognition is important because some patients improve with treatment.
Lyme disease is increasingly recognized as a potential neurologic cause of vocal cord paralysis and voice dysfunction.
Although uncommon, Lyme-related nerve inflammation may affect the recurrent laryngeal nerve or other neurologic pathways involved in speech and swallowing.
Patients may develop hoarseness, weak voice, difficulty swallowing, breathing problems, or even temporary loss of vocal function.
Because vocal cord paralysis has many possible causes, Lyme disease may be overlooked unless clinicians consider infectious and neurologic explanations.
How Lyme Disease Can Affect the Vocal Cords
The vocal cords rely on precise nerve signaling to open and close properly during speaking and breathing.
Lyme disease may affect these nerves through neuroinflammation or direct neurologic involvement associated with neuroborreliosis.
“Lyme can affect the nerves that are responsible for controlling the muscles in the vocal cords,” explained infectious disease specialist Amesh A. Adalja, MD.
When these nerves become impaired, patients may experience:
- Hoarseness
- Voice fatigue
- Weak voice projection
- Difficulty swallowing
- Choking episodes
- Breathing difficulty
- Temporary voice loss
Some patients also report overlapping neurologic symptoms such as brain fog, balance problems, facial weakness, or autonomic dysfunction.
Evidence Linking Lyme Disease and Vocal Cord Paralysis
A 2016 case series published in the Journal of Voice identified Lyme disease among several infectious causes of vocal cord paralysis and paresis.
The investigators reviewed 231 Pennsylvania patients with vocal fold paralysis or paresis and found Lyme disease occurred at a significantly higher rate than expected.
Five patients tested positive for Lyme disease using confirmatory Western blot testing.
The authors emphasized the importance of identifying treatable causes of vocal cord paralysis, particularly in endemic regions.
Case Reports of Lyme-Related Vocal Cord Paralysis
Several published case reports further support a possible association between Lyme disease and vocal cord dysfunction.
One report described a 90-year-old man with bilateral vocal cord paralysis, respiratory failure, and weakness affecting both upper and lower extremities.
The patient tested positive for Lyme disease and improved after intravenous ceftriaxone treatment.
Another report described two patients with vocal fold paresis secondary to neuroborreliosis who experienced favorable outcomes following antibiotic therapy.
A separate 1988 report described a 45-year-old singer who developed sore throat, hoarseness, and neuralgia before testing positive for Lyme disease.
After doxycycline treatment, her speaking and singing ability gradually returned.
Why Lyme Disease May Be Missed in Voice Disorders
Most clinicians first evaluate vocal cord paralysis for more common causes such as surgery, tumors, trauma, or degenerative neurologic disease.
Infectious causes may not initially be considered.
This is one reason Lyme disease vocal cord paralysis may be underrecognized.
Patients living in endemic areas or those with unexplained neurologic symptoms may require broader evaluation.
For additional discussion of delayed recognition, see Delayed Lyme Disease Diagnosis.
Neurologic Lyme Disease Can Affect Multiple Cranial and Peripheral Nerves
Lyme disease is well known for causing facial nerve palsy, but other cranial and peripheral nerves may also be affected.
Inflammation involving the recurrent laryngeal nerve or related neurologic pathways may contribute to hoarseness and vocal dysfunction.
Because neurologic Lyme disease can produce fluctuating symptoms, patients may experience periods of improvement followed by recurrence.
Learn more about broader neurologic complications in Neurologic Lyme Disease.
Frequently Asked Questions
Can Lyme disease cause vocal cord paralysis?
Yes. Although uncommon, Lyme disease may affect nerves controlling the vocal cords and contribute to vocal cord paralysis or paresis.
What voice symptoms can occur with Lyme disease?
Patients may experience hoarseness, weak voice, voice fatigue, swallowing difficulty, choking episodes, or temporary voice loss.
Is Lyme disease vocal cord paralysis treatable?
Some published case reports describe improvement after antibiotic treatment, particularly when Lyme disease is identified early.
Why is Lyme-related vocal cord paralysis often missed?
Because vocal cord paralysis has many possible causes, infectious explanations such as Lyme disease may not initially be considered.
Can neurologic Lyme disease affect other nerves?
Yes. Lyme disease may affect cranial nerves, peripheral nerves, and autonomic pathways in some patients.
Clinical Takeaway
Lyme disease vocal cord paralysis is uncommon but clinically important because it may represent a treatable neurologic complication of infection.
Patients with unexplained hoarseness, vocal weakness, swallowing difficulty, or recurrent vocal cord dysfunction—especially in endemic regions—may warrant evaluation for neurologic Lyme disease.
Related Articles
Learn more about diagnostic confusion in Lyme Disease Misdiagnosis.
Explore persistent neurologic symptoms in Post-Treatment Lyme Disease Syndrome.
Review overlapping infections in Lyme Coinfections.
Explore autonomic overlap in Autonomic Dysfunction in Lyme Disease.
See broader symptom patterns in the Lyme Disease Symptoms Guide.
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 requiring tracheostomy due to neuroborreliosis. CHEST Journal. 2014.
- Martzolff L, et al. Recurrent nerve palsy due to Lyme disease: report of two cases. Rev Med Interne. 2010;31(3):229-31.
- Schroeter V, Belz GG, Blenk H. Paralysis of recurrent laryngeal nerve in Lyme disease. Lancet. 1988;2(8622):1245.
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.