I have been hoarse for about four weeks, since I had flu. An otolaryngologist found no problems with tumors or growths but did find that the right vocal cord is cupped for some reason -- like it is sagging. He is sending me to a specialist in the care of the voice. My main question is: About a week before I had the flu I got a flu shot. Could the flu shot have attacked my nerves and caused the hoarse voice? Is there treatment to repair a cupped or sagging vocal cord?

Otis

There is such a thing as idiopathic vocal-cord paralysis. ("Idiopathic" is a polite way of saying that your doctor does not know what caused the problem.) As with Bell's palsy, which is an idiopathic paralysis of the nerve that controls the muscles of facial expression, experts speculate that a viral infection may be the cause of the paralysis. Flu vaccines do not contain intact flu virus particles, however. You cannot catch the flu from a flu shot. Thus, the flu shot almost certainly did not cause your hoarseness.

You have described the appearance of your vocal cords very well. This sounds like vocal-cord bowing, and does NOT sound like a vocal-cord paralysis. If you understand how a bowed vocal cord results in hoarseness, you will then understand how this situation can be surgically corrected. The two vocal cords are attached at one end, forming a V. The V is open while you breathe. When you speak, the V closes, like so: ||. If one cord is bowed, then it probably looks a bit like this when you speak: |). There is a gap, and breath escapes through this gap while you speak. Also, vocal cords vibrate during speech. Normal vibration depends, in part, on the || position. A bowed cord may not vibrate normally. The result is a breathy, low-volume and possibly hoarse voice.

I think it is great that your ear, nose and throat doctor (ENT) is sending you to a voice specialist. Such specialists (who are called laryngologists) do nothing but work with patients with laryngeal (voice-box) problems. This specialist will be able to confirm your ENT's diagnosis and will be able to offer you a variety of treatment options.

One treatment option, certainly, would be "tincture of time." Wait it out, in other words. Assuming that your doctor has eliminated the ominous possibilities, such as cancer, then there should be no harm in giving this problem time to resolve without specific treatment.

The more aggressive option would be to push the bowed cord back into a more normal position. This can be accomplished (under anesthesia) by injecting a substance to the side of the bowed cord. The laryngologist can harvest a small amount of fat from your belly region and inject this fat next to the bowed cord. Alternatively, he or she may choose to inject a substance called Gelfoam. Both are considered temporary treatments, though the fat injection probably provides longer-lasting results.

There is also a more permanent surgical "fix" to this problem, but since you have been hoarse for only four weeks, this would be inappropriate (in my opinion). The permanent solution requires placement of a small plastic block immediately to the side of the bowed cord. This is a reversible procedure (the block can be removed later), but reversal involves a second operation.