Abstract
Introduction: Cardiovocal syndrome, or hoarseness resulting from vocal fold paralysis secondary to cardiovascular pathology, is commonly referred to as Ortner’s syndrome. We present a brief overview of vocal fold paralysis, present an illustrative case of Ortner’s syndrome, and provide a review of the pertinent literature. Here we aim to broaden one’s differential for vocal fold paralysis, discuss its importance as pertains to cardiovascular pathology and outcomes, and highlight the difficulties in therapeutic planning for these unique patients. Methods: A case report and literature review. Results: A 26-year-old female with an atrial septal defect and pulmonary hypertension presented with 5 months of hoarseness. Laryngoscopy revealed left vocal fold paralysis. Imaging from the skull base to chest showed an enlarged pulmonary artery (PA) in the absence of other abnormalities. Literature review suggests that this left laryngeal nerve paralysis results from nerve compression within the aortopulmonary window, a triangle defined by the aortic arch, PA, and ligamentumarteriosum. Imaging in our patient over 8 months demonstrated an increase in PA size from 3.9 to 4.2 cm correlating with the onset of hoarseness. Conclusions: Importantly, hoarseness second ary to laryngeal nerve compression in cardiovascular disease may correlate with a poorer prognosis, i.e., in thoracic aortic aneurysms and mitral valvestenosis. Awareness of vocal changes in the setting of cardiovascular disease improves diagnostic acumen in vocal foldparalysis.
Highlights
Case ReportA 26-year-old Hispanic female was referred to otolaryngology for 5 months of hoarseness
Cardiovocal syndrome, or hoarseness resulting from vocal fold paralysis secondary to cardiovascular pathology, is commonly referred to as Ortner’s syndrome
Described in 1897, Ortner’s syndrome detailed a left VFP resulting from recurrent laryngeal nerve compression within the aortopulmonary window, a triangle defined by the aortic arch, pulmonary artery, and ligamentumarteriosum [2] [3]
Summary
A 26-year-old Hispanic female was referred to otolaryngology for 5 months of hoarseness. One-year prior she was in her usual state of health training for Navy boot camp when she developed a progressive productive cough She was found to have pneumonia, but among her work-up an EKG demonstrated right ventricular hypertrophy prompting referral to a cardiologist. A transthoracic echo was performed which demonstrated pulmonary hypertension with a dilated right atrium and ventricle Weeks later she developed significant and sudden dyspnea on exertion and her exercise tolerance drastically diminished. We discussed the temporary benefits she could obtain from an injection laryngoplasty but she elected against this option Given her mild symptoms, the possibility of recovering nerve function by addressing her cardiovascular disease, and her high operative risk, the risks of proceeding with a more definitive laryngeal intervention on aggregate outweighed the benefits. As such we elected to awaither cardiovascular treatment and recovery
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