Monday, April 28, 2014

Consequences of Choking--How to Write it

I've put down "The choking damaged his vocal chords" in a scene. Can that actually happen?
 If so, could it lead to never regaining speech? If not... how can I make it happen?

I wasn’t sure what kind of choking you planned to use, so here are both:

External choking (strangulation, homicidal or otherwise) can cause damage to the nerves that supply the vocal cords. It can also cause fracture of the cartilage that surrounds/protects the vocal cords or separation/tearing of these cartilages.

 Two possible consequences of this type of choking:

1)      Vocal cord weakness—this results in hoarseness and early “voice fatigue” when speaking.

2)      Vocal cord paralysis—victim can’t speak, and has trouble protecting airway from secretions like saliva and postnasal drainage.

I’ve included a color drawing to help you visualize the anatomy.

Internal choking (like on food or a foreign body) can cause direct trauma to the vocal cords. Hoarseness and voice fatigue can ensue. Permanent paralysis of the vocal cords is less likely with this kind of injury; therefore not being able to talk at all would be less likely. It could happen, though. (See b/w drawing below)

In the black and white drawing, the vocal cords are the long thin structures adjacent to black oval in the middle.


If I go with vocal cord weakness... would it be logical for the victim to be unable to talk during his recuperation period?  I need him unable to talk for at least a while (even when he finally regains consciousness).
 Regarding vocal cord paralysis…what are the consequences of being unable to protect the airway from secretions?   

Certainly would be okay for the victim not to be able to talk during initial recovery. The nice thing about a nerve injury is you can control the extent. With external choking, there's bound to be some swelling which will push on the nerves to the vocal cords, in turn leading to weak or no movement of the vocal cords and little or no speech.

 The biggest thing about not being able to protect the airway is saliva, food, drink, etc may end up in the lungs. The recurrent laryngeal nerve supplies sensation to this area, and if no "invaders" are sensed, they can travel downward. The other issue is effective cough. Receptors in the airways send information to the brain, and the brain tells the vocal cords to close, the glottis (path to the stomach) to close, and then generates cough via rapid contraction of the stomach (abdominal) muscles. The air passes between the cords.

Without this sequence working, it's easier for stuff to go down the "wrong pipe," ie, the trachea instead of the esophagus (swallowing tube.)

You may consider also that your victim may need a temporary airway called a tracheostomy when initially injured. This is a hole in the trachea, below the damaged area, that allows free air movement into the lungs. This hole can be closed as the victim recovers.

I hope this helps; if you can give me more details about your scenario, I can offer more specific suggestions.

Good Luck!

Questions? Comments?
 Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
 Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous. Find Kelly’s fiction at

Pictures courtesy of ADAM and MACC, respectively.


  1. This post was great, Kelly. I looked at some of your other blogs. I'm bookmarking your site. It will be great for reference. Thank you.

    1. Glad you found it helpful, Susan!

  2. Permanent paralysis of the vocal cords is less likely with this kind of injury; therefore not being able to talk at all would be less likely. It could happen, though. how to pass a swab test