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The voice box, or larynx, has three important functions. It is necessary for breathing, voice and swallowing. The vocal folds have two positions, open (apart) for breathing (picture I) and closed (together) for making sound, coughing and sealing off the lungs when swallowing (picture II). When one of the vocal folds are paralyzed, it usually rests in an in-between position (picture III), and neither opens for breathing, nor closes for voicing, coughing, or swallowing. Usually, the effects on the voice are the most dramatic. The voice becomes weak and breathy. People can only say a few words per breath, and are frequently out-of-breath, or physically tired when trying to speak for more than a few minutes straight. The voice may also get somewhat high and squeaky, with a diminished range. Swallowing may be affected as well, where you may notice some choking or coughing with certain liquids. Your cough is frequently different and very weak. This is a serious problem for patients with with vocal fold paralysis because one of the most important functions of the larynx is to keep liquids out of the lungs, and to be able to cough up mucus. When this does not happen, you are at risk for getting an "aspiration" pneumonia. The surgical procedure to restore these important functions is called "medialization laryngoplasty"

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