The Use of Botox in the Treatment of Post Cardiac Surgery Paradoxical Vocal Cord Movement

Abstract

Paradoxical vocal cord movement (PVCM) is a laryngeal disorder characterised by paradoxical adduction of the vocal cords during inspiration, expiration, or both. In severe cases patients can present with acute respiratory failure requiring intubation and mechanical ventilation. Paradoxical vocal cord movement can be due to different conditions including central nervous system injury, conversion disorders, psychological stress, inhaled irritants, and true laryngeal dystonias. Paradoxical vocal cord movement has also been described in association with cardiac surgery. Most cases of mild PVCM are successfully treated with a combination of speech therapy, patient education, and psychotherapy. In severe cases, patients might require tracheostomy. We report a case of a 65 year-old man who developed severe PVCM post coronary artery bypass surgery requiring tracheostomy for six months. He was successfully treated with bronchoscopic injection of Botulinum toxin type A into his vocal cords. He was decannulated one week after the injection, and was doing well at six weeks follow up.