Christella Antoni explains that clients often feel frustrated, disappointed, and shocked after surgery because they did not expect it to significantly affect their voice. The severity of vocal changes depends on how much tissue had to be removed, and more serious injury—such as cutting a nerve—can cause one-sided vocal cord paralysis. Because the vocal cords must meet and touch to produce a clear sound, reduced movement in one cord can leave a gap that allows air to escape, resulting in a hoarse voice.