Case Of Vocal Cord Paralysis Research Articles

Cardio-vocal syndrome revisited

Ortner Syndrome or Cardiovocal Syndrome encompasses any cardiovascular cause causing vocal cord paralysis by compression of the recurrent laryngeal nerve along its pathway. Historically, it was described as a case of vocal cord paralysis due to an enlarged left atrium compressing on the left recurrent laryngeal nerve in mitral valve stenosis. We describe a case of 71 years male, who presented with insidious onset hoarseness of voice. Contrast-enhanced computed tomography neck and chest revealed two aneurysms from the arch of aorta compressing on the left recurrent laryngeal nerve. With other causes being ruled out, the diagnosis of Cardiovocal syndrome was retained.

Impact of COVID-19 on vocal cord mobility: a case series study

BackgroundThe World Health Organization (WHO) has declared the pandemic of COVID-19 infection in March 2020, most of cases presented with mild symptoms, and a significant number of cases showed variable neurological pictures. Vocal cord paralysis with no clear cause is termed as idiopathic vocal cord paralysis and supposed to be caused by viral infection. This is a case series study; data were collected prospectively from patients presented to the ENT clinic of Kasr Alainy (Cairo university) and Railway hospitals. Patients presented with defective vocal cord movement with concurrently or recently passed COVID-19 infection were reported from March 2020 to April 2021.ResultsAuthors have reported 6 cases of vocal cord paralysis mainly unilateral due to COVID-19 infection as an only clear cause within 14 months. Age ranges from 39 to 69 years, 2 males and 4 females. Patients presented with different clinical scenarios. Follow-up of the cases showed spontaneous recovery in 5 cases and one case underwent cord medialization.ConclusionViral infection could be an underlying cause of idiopathic laryngeal cord paralysis; in the new era of the COVID-19 pandemic, physicians all over the world noticed variable neurological pictures; in this study, we presented 6 cases of vocal cord paralysis mainly unilateral supposed to be due to COVID-19 infection; all cases showed spontaneous recovery apart from one case that needed medialization of the cord.

Recovery of Vocal Cord Motion Among Pediatric Patients.

Patients with vocal cord paralysis can experience feeding, respiratory, and vocal problems leading to disability and decreased quality of life. Current evidence suggests waiting a period of 12 months for spontaneous recovery before permanent interventions. This study aims to determine the time to recover spontaneously and vocal cord movement in a pediatric population and create a model for evidence-based patient counseling. Retrospective longitudinal cohort study. The report is a single institution longitudinal study on vocal cord paralysis recovery. Patients were categorized based on spontaneous recovery with vocal cord movement or no recovery. Recovery rates were determined using the Kaplan-Meier method. Of 158 cases of vocal cord paralysis over a 4-year period, 36 had spontaneous recovery with symptom improvement and motion return. The average recovery was 8.8 months for those who recovered, and 78% recovered within 9 months. Two groups emerged from the data: an early recovery group with spontaneous recovery before 12 months and a late recovery group after 12 months. Children with dysphonia and paralysis due to cardiac surgery were less likely to recover, and children with aspiration were more likely to recover. Children with gastrointestinal comorbidities were less likely to recover; however, those who did recover were more likely to have recovered after 12 months. Based on our model, there is about a 3% chance of recovery between 9 and 12 months. Patients should be counseled about earlier interventions. Waiting the conventional 12 months for only a 3% chance of spontaneous recovery without intervention or laryngeal EMG may not be the preferred option for some patients and their families.

A case of vocal cord paralysis after thyroid nodule microwave ablation

Most thyroid nodules show benign features and some of them need treatment for various reasons. Treatment options include levothyroxine, ethanol injection, laser ablation, radiofrequency ablation, and thyroid surgery. The use of the microwave ablation technique presented in thyroid nodules has been reported in recent years. The wider ablation zone, shorter processing time, and prominent tumor death stand out as a targeting process, as well as creating unwanted effects such as heat sensation, pain, bleeding, fever, cough, swallowing abnormalities, and sound changes. The risk of nerve damage is very low in the microwave ablation technique. In the case of recurrent nerve paralysis, it is important to perform a laryngoscopic examination by the otolaryngologist and to call the patient for monthly outpatient clinic controls to check for temporary or permanent paralysis. In this case report, a 56-year-old woman who developed vocal cord paresis after a minimally invasive microwave ablation procedure, which has gained importance in recent years, was presented radiologically and clinically.

Vocal Cord Paralysis and Dysphagia as Sequelae of Gradenigo Syndrome

Objectives: To present a case of vocal cord paralysis and dysphagia developing in Gradenigo syndrome and to discuss its clinical presentation, differential diagnosis and therapeutic approach.
 
 Methods:
 Design: Case Report
 Setting: Tertiary Government Hospital
 Patient: One
 
 Results: A 54-year-old lady was admitted with a six month history of left-sided otorrhea, cheek and jaw pain, three months otalgia, and recent-onset hoarseness, dysphagia and diplopia on a background of mastoidectomy at age 6. Otoscopy revealed granulation tissue and chlolesteatoma occupying the left external auditory canal. There was left vocal cord paralysis with pooling of saliva in the pyriform sinus, left lateral gaze paralysis, and left facial nerve paralysis. CT scan revealed sclerosis of the left petrous apex and leptomeningeal enhancement on the left temporal lobe. Chronic suppurative otitis media with cholesteatoma and Gradenigo syndrome was diagnosed, and canal wall down mastoidectomy was performed Postoperatively, the otalgia and pain over the left jaw diminished in intensity while hoarseness and left lateral gaze palsy remained.
 
 Conclusion: Gradenigo syndrome is known for its triad of retro-orbital pain, lateral gaze paralysis, and chronic middle ear infection due to petrous apicitis. Although rare, vocal cord paralysis and dysphagia may develop when infection traverses and encroaches on the jugular foramen where cranial nerves IX, X, and XI are lodged. Knowledge of the syndrome should not be limited or confined to the classic triad. Practicing ear specialists should be vigilant and cognizant of the clinical manifestations and sequelae of chronic middle ear infection. Prompt surgical intervention is crucial while resolution of the disease may vary for different individuals.
 
 Keywords: Chronic otitis media, Gradenigo syndrome, vocal cord paralysis, petrous apicitis

咽喉頭症状を呈した水痘・帯状疱疹ウイルス感染症の2例

Involvement of the cranial nerves during the reactivation of varicella zoster virus (VZV) is known as Ramsay Hunt syndrome (RHS) and can result in paralysis of the facial muscles (cranial nerve VII) and damage to the vestibulocochlear nerve (cranial nerve VIII) with the formation of cutaneous ear vesicles. The involvement of cranial nerves other than VII and VIII sometimes occurs during the reactivation of VZV and can result in paralysis of the soft palate or vocal cords, etc. These effects typically arise from the involvement of the glossopharyngeal nerve (cranial nerve IX) or the vagus nerve (cranial nerve X). Initial symptoms can include a sore throat, hoarseness, and dysphagia, and a physical examination may reveal vesicular eruptions over various parts of pharyngolaryngeal mucosa. A pharyngolaryngoscopic examination may reveal eruptions on a unilateral side of the pharyngeal, laryngeal or epiglottic mucosa, with paralysis of the vocal cords or salivary storage in a unilateral piriform fossa. Here, we report two cases of vocal cord paralysis caused by VZV reactivation: a case with RHS and paralysis of the vocal cords, and a case with dysphagia and paralysis of the vocal cords and a sore throat as the initial symptoms.

A Few Unusual Cases of Benign Laryngeal Lesions - Our Experience

Introduction: Benign laryngeal lesions may have some uncommon presentations. 
 Aims: The aim was to identify unusual benign vocal cord lesions and review their management and follow up. 
 Material and methods: The records of the patients presenting with different benign vocal cord lesions were reviewed retrospectively. Confirmed cases of vocal cord paralysis and malignancy were excluded from the study. Nine cases were imcluded in this study. Clinical findings, investigation reports, treatment and outcome were analysed. 
 Results: Most of the patients were from 18 years to 52 years (66%). Most common presenting feature was hoarseness of voice (89%) followed by respiratory distress (33%) . Microlaryngeal surgeries were done in 7 patients (78%) and 2 patients (22%) were managed conservatively. 
 Conclusion: Diagnosis of benign vocal cord lesions may sometimes be difficult. Careful history, attention to the anatomy and the probable variations in presentation of the benign lesions of larynx, thorough clinical examination and different diagnostic tools are essential for satisfactory management.

輪状甲状靭帯穿刺部の誤りにより声帯麻痺を生じた1例

輪状甲状靭帯穿刺・切開は耳鼻咽喉科のほか，救急科や外科でも行われる手技である。日本気管食道科学会の行ったアンケートでは術中合併症として出血，皮下気腫などが多く，穿刺部の誤りは調査中25％の医師が経験している。今回，輪状甲状靭帯穿刺部の誤りがあり，声帯麻痺を生じた症例を経験した。症例は82歳男性，大動脈弁置換術後である。喀痰排出困難があり担当医によりミニトラックの挿入が行われた。一般病棟に転棟後，嚥下評価目的に当科紹介となった。喉頭内視鏡では右声帯を貫くようにチューブが留置されており，頸部CT検査では甲状軟骨右板，右声帯を貫くことが確認された。気管切開術を行い，声門の経過観察を行ったが両声帯麻痺の状態がつづき気管孔管理が必要な状態で転院となった。これまでも輪状甲状靭帯穿刺・切開による声門下狭窄の報告は散見され，予防のためには正しい位置に挿入する，長期留置を避ける，などの考察が行われている。留置期間や合併症について報告する。

Vocal cord paralysis caused by stingray

Foreign bodies in the oral cavity and pharynx are commonly encountered in the emergency room and outpatient departments, and the most frequently observed of these foreign bodies are fish bones. Among the possible complications resulting from a pharyngeal foreign body, vocal cord fixation is extremely rare, with only three cases previously reported in the English literature. The mechanisms of vocal cord fixation can be classified into mechanical articular fixation, direct injury of the recurrent laryngeal nerve, or recurrent laryngeal nerve paralysis secondary to inflammation. The case discussed here is different from previous cases. We report a rare case of vocal cord paralysis caused by the venom of a stingray tail in the hypopharynx.

Minimally invasive video‐assisted thyroidectomy 2.0: Expanded indications in a tertiary care cancer center

Minimally invasive video-assisted thyroidectomy (MIVAT) advantages include a smaller incision, less extensive surgical dissection, improved visualization secondary to rigid fiberoptics, and decreased postoperative pain. The aims of our study were to report our experience using expanded indications of MIVAT. A retrospective chart review of a single surgeon's initial experience was carried out at a tertiary academic cancer center. In all, 53 patients were identified, of whom 40 underwent total thyroidectomy and 13 underwent hemithyroidectomy. Thyroid volume, nodule size, incision length, and surgical time were all examined. Most common pathology was well-differentiated papillary thyroid cancer (69.8%): 42% of patients had evidence of thyroiditis found on pathology; 17% of patients had temporary vocal cord paralysis, with only 1 case of vocal cord paralysis persisting >6 months (1.9%). Six patients (11%) experienced temporary hypocalcemia, requiring postoperative calcium supplementation; no patients experienced permanent hypocalcemia. The use of MIVAT with expanded indications shows complication rates comparable to those of traditional open thyroidectomy.

TRANSIENT UNILATERAL VOCAL CORD PARALYSIS DURING ENDOSCOPIC ULTRASOUND

To the Editor, Endoscopic ultrasound (EUS) is generally a safe procedure. However, the longer, rigid tip of the echoendoscopes raises concern about cervical esophageal perforation during intubation.1 Iatrogenic injury of the recurrent laryngeal nerve is the most common cause of vocal cord paralysis.2 We report a case of esophageal perforation and vocal cord paralysis associated with EUS. A 67-year-old man was referred to our hospital because of progressive dysphagia. The endoscopic ultrasound revealed a normal esophagus. The patient developed neck pain and painful swelling after the examination. Physical examination demonstrated that it was not cervical crepitus, and neck radiograph revealed air in the retropharyngeal space. Indirect laryngoscopy showed paralysis of the right vocal cord. The left vocal cord was normal with no ulceration or growth. Assessment and diagnosis of the vocal cord paralysis by otorhinolaryngologists after EUS included interviews and flexible fiberscopy. There were no previous clinical symptoms of neuropathy and no positive history for inherited neuropathies. Computed tomography (CT) scan of the neck and thorax showed perforation of the right pyriform sinus and the presence of a right-sided large laryngocele. Oral intake was withheld and high-dose antibiotics and prednisone (40 mg/day) were administered through the central venous system over 10 days. The patient reported that voice quality and perforation improved suddenly after 10 days of medication. Subsequent laryngoscopy and flexible fiber optic endoscope showed normal movement of the left vocal cords. Control CT scan of the neck and chest obtained 10 days after the first one did not show gas or fluid collection in the right pyriform sinus. Oral intake was restarted on the 10th day and the patient was discharged on the 11th day. EUS have become important tools in evaluation of patients who have various gastrointestinal and non-gastrointestinal disorders, and are being increasingly utilized at many centers.3 EUS is generally a safe procedure. Complications can occur but are rare.2 Vocal cord paralysis may occur for many reasons. The most common cause of esophageal perforation is injury to the esophagus during a medical procedure, such as intubation with inadvertent placement of the tracheal tube in the esophagus, nasogastric tube placement, upper gastrointestinal endoscopy and transesophageal echocardiograph.4 To our knowledge, this is the first reported case of vocal cord paralysis in a patient undergoing EUS. The cause of the complication was damage to the right recurrent laryngeal nerve, which occurred during insertion of the EUS into the esophagus.

Invasion of the Recurrent Laryngeal Nerve by Tracheal Tumor

Vocal cord paralysis and goiter are 2 common problems encountered in otolaryngology practice. Their coexistence, however, should arouse suspicion of the presence of malignant thyroid disease. Primary tracheal cancer is uncommon, and its incidence is very low compared with laryngeal cancer. Primary tracheal tumors can cause recurrent nerve palsy. We report here a rare case of vocal cord paralysis caused by a clinically occult tracheal squamous cell carcinoma in an 80-year-old patient with coincidental huge multinodular goiter.

Sequelae of recurrent laryngeal nerve injury after patent ductus arteriosus ligation

To prospectively study the clinical course of neonates with vocal cord paralysis (VCP) after patent ductus arteriosus (PDA) ligation. A prospective cohort study of all premature infants undergoing PDA ligation from March 2001 to February 2004. Flexible laryngoscopy was performed after extubation to assess vocal cord function. Data regarding patient characteristics, operative findings, post-operative endoscopic findings, and the subsequent clinical course were collected. One hundred patients were enrolled. Flexible laryngoscopy was performed on 61 patients. Median birth weight was 740 g, gestational age 25 weeks, and age at operation 23 days. Flexible laryngoscopy was performed at an average of 8 days after extubation. Seven cases of vocal cord paralysis were identified. Two had stridor and feeding difficulty requiring nasogastric feeding. Five of the seven had an average follow-up of 9 months after surgery. At last follow-up, endoscopically satisfactory compensation by the normal vocal cord was observed in all five patients. No patient had feeding problems. The majority of infants who can be successfully extubated after PDA ligation tend to be asymptomatic despite vocal cord paralysis. Compensation appears to occur rapidly, and patients generally have no *long-term problems with the airway or feeding.

Sequelae of Recurrent Laryngeal Nerve Injury after Patent Ductus Arteriosus Ligation

Summary Objectives To prospectively study the clinical course of neonates with vocal cord paralysis (VCP) after patent ductus arteriosus (PDA) ligation. Methods A prospective cohort study of all premature infants undergoing PDA ligation from March 2001 to February 2004. Flexible laryngoscopy was performed after extubation to assess vocal cord function. Data regarding patient characteristics, operative findings, post-operative endoscopic findings, and the subsequent clinical course were collected. Results One hundred patients were enrolled. Flexible laryngoscopy was performed on 61 patients. Median birth weight was 740 g, gestational age 25 weeks, and age at operation 23 days. Flexible laryngoscopy was performed at an average of 8 days after extubation. Seven cases of vocal cord paralysis were identified. Two had stridor and feeding difficulty requiring nasogastric feeding. Five of the seven had an average follow-up of 9 months after surgery. At last follow-up, endoscopically satisfactory compensation by the normal vocal cord was observed in all five patients. No patient had feeding problems. Conclusions The majority of infants who can be successfully extubated after PDA ligation tend to be asymptomatic despite vocal cord paralysis. Compensation appears to occur rapidly, and patients generally have no *long-term problems with the airway or feeding.

Hybrid Endograft for One-Step Treatment of Multisegment Disease of the Thoracic Aorta

At present, a two-step surgical approach is necessary to treat patients with coexistent pathologic conditions involving the proximal and descending thoracic aorta. A hybrid endograft is described here that enables such treatment during a single operation. The Chavan-Haverich endograft consists of a Dacron vascular prosthesis with stainless-steel stents affixed at its distal end. After approval by the institutional review board, the endograft was prospectively implanted in 22 patients with multisegment thoracic aortic disease (13 men, nine women; median age, 64 years). Eleven patients had type A dissections (one acute, 10 chronic), four had a chronic type B dissection, and seven had atherosclerotic aneurysms of the ascending aorta or aortic arch as well as of the descending aorta. Of these patients, 11 additionally required aortic valve replacement or coronary artery bypass grafting. Via median sternotomy, the aortic arch was opened in circulatory arrest. After antegrade deployment of the stent-containing portion in the descending aorta, the proximal non-stent-containing endograft was used to reconstruct the aortic arch. Median follow-up was 14 months. Endograft implantation was successful in all but one patient. Complications included neurologic deficits that were transient in one case and lasting in two, two cases of vocal cord paralysis, and one death. In all patients with atherosclerotic aneurysms who received the endograft (six of seven), aneurysm thrombosis was noted at follow-up. In aortic dissections, partial or complete false-lumen thrombosis to the level of the stents occurred in all patients. None of the patients showed a progressive widening of the descending aorta. The Chavan-Haverich endograft enables one-step treatment of multisegment pathologic conditions affecting the thoracic aorta that otherwise would require two or more operations.

Congenital laryngeal stridor

We reviewed the diagnosis, complications and treatment of congenital laryngeal stridor (CLS), in 97 patients who consulted our clinic between 1991 and 2001. The 97 patients were diagnosed with laryngeal malacia (32%), vocal cord paralysis and laryngeal stenosis (22%), a neoplastic disease like hemagioma and papilloma (11%), or cystic disease (7%). The cases with vocal cord paralysis, laryngeal stenosis or laryngeal cysts were usually diagnosed within 2 months of birth based on severe dyspnea. Two of the 31 cases of laryngeal malacia and 2 of the 22 cases of vocal cord paralysis were associated with neuromuscular disorders. Three patients suffered from vocal cord paralysis complicated by laryngeal stenosis. Thirty-three of the 97 cases required a tracheostomy; these 33 cases included the one case of laryngeal papilloma (100%), 9 of the 10 cases of hemangioma (90%), and 18 of the 24 cases of laryngeal stenosis (75%). Since any disorders of the upper airway can potentially induce stridor, establishing an accurate diagnosis is sometimes difficult when stridor is the only presenting symptom. Hence, information on associated symptoms and the past history of the subject is particularly important for an accurate diagnosis. In addition, decisions regarding the course of treatment course require adequate consideration of possible complications.

Esophageal Stethoscope

• Hoarseness after endotracheal intubation can result from compression of the anterior branch of the recurrent laryngeal nerve as it passes behind the thyroid cartilage to innervate the lateral cricoarytenoid muscle. This usually occurs when the cuff of the endotracheal tube lies in the larynx instead of the trachea. When a nasogastric tube is positioned in the midline, resultant postcricoid inflammation can result in vocal cord immobility. This may result from neuropraxia of the posterior branch of the recurrent laryngeal nerve that innervates the posterior cricoarytenoid and interarytenoid muscles, or inflammatory spasm of the interarytenoid muscles themselves. We present a case of vocal cord paralysis after general anesthesia that may have been caused by an esophageal stethoscope. The mechanism for vocal cord immobility could be similar to that of a midline nasogastric tube with resultant postcricoid inflammation. We describe measures that can be taken to prevent vocal cord paralysis after intubation of the larynx or esophagus. ( Arch Otolaryngol Head Neck Surg 1989;115:95-98)

Vocal cord paralysis following child abuse

Otorhinologic manifestations of child abuse are infrequently reported in the literature. Three cases of vocal cord paralysis following child abuse are presented. The pathophysiology of vocal cord paralysis is reviewed as it relates to pediatric vocal cord paralysis. Recognition of the possibility of vocal cord paralysis in an abused child who suffers significant head trauma or a strangulation injury is necessary to insure a more rapid diagnosis and initiation of effective therapy more promptly.

Vocal cord paralysis in small children: principles in management.

Vocal cord paralysis in children is an uncommon but often disabling problem. It may be congenital or acquired either in the immediate period surrounding birth or as a postpartum event. Because even unilateral vocal cord paralysis can result in severe respiratory distress in the newborn and in small children, recognition of this problem can be critical. A logical approach to diagnosis and management requires not only that the physician be alert to the problem but also that several procedures be established that can be used together or singly to address the problem, as is most appropriate to the individual case. The usefulness of intubation, tracheotomy, surgical lateralization of the vocal folds, and reinnervation in the management of these problems is discussed, and 30 cases of vocal cord paralysis in children under the age of 5 years are presented.

Vocal Cord Paralysis (VCP)—An Aetiologic Review of 100 Cases Over 20 Years

A retrospective analysis of the aetiology of 100 cases of vocal cord paralysis (VCP) seen over two consecutive decades at a large general hospital has been performed. One half of the cases seen were due to malignancy, mainly carcinoma of lung; 16% of cases were due to trauma or surgical procedures, while cardiac and neurological-related diseases were associated with 7% and 6% of cases respectively and miscellaneous causes accounted for 6%. Fifteen per cent of all cases remained undiagnosed. When the first and second decades were compared for evolving trends, there was a decrease in the incidence of VCP as a complication of lung cancer, but not significant change following thyroid surgery. The nature of idiopathic VCP is discussed in some detail.