Silenced by heart – Ortner’s syndrome (cardio-vocal hoarseness) – An unusual manifestation of a distant dreadful disease: A cross-sectional observational study

Abstract

ABSTRACT Aims and Objectives: This study aims to explore the pathogenesis of hoarseness of voice resulting from cardiovascular disorders that affect the left recurrent laryngeal nerve (LRLN), supported by a review of the existing literature. Materials and Methods: This is a cross-sectional observational study conducted over a 3-year period, spanning from May 2019 to May 2022. The study involved the evaluation of 720 cases of hoarseness of voice through video-laryngoscopy. Within this cohort, we scrutinized eight distinct cases of Ortner’s syndrome, each attributed to various underlying causes. All patients with LRLN paralysis underwent a comprehensive clinical assessment, which encompassed chest X-rays, echocardiography, and chest computed tomography scans. Results: Out of the eight Ortner’s syndrome cases, six were associated with dilated pulmonary arteries, stemming from various etiologies such as rheumatic heart disease, mitral valve prolapse, pulmonary embolism, interstitial lung disease, portopulmonary hypertension, and patent ductus arteriosus. One case presented with pericardial effusion and pulmonary hypertension, while another case featured a dilated aorta secondary to severe aortic regurgitation. Among these cases, three patients underwent valve replacement, one underwent pericardiocentesis, and the remaining cases were managed conservatively. Only one case that underwent mitral valve replacement showed partial improvement in voice, while there was no significant improvement in the other cases. All cases remained under follow-up. Conclusion: Although cardiovascular-related hoarseness is an unusual presentation, it should be kept in mind for all cases of altered voice with underlying cardiac disease. Indirect laryngoscopy should be routinely performed in all cases of cardiac illness having hoarseness of voice.