Cause Of Vocal Cord Paralysis Research Articles

A vocal cord palsy caused by the uterine cancer metastatic tumor in the mediastinum revealed in a patient with a thyroid lesion: a case report and review of the literature

BackgroundThe main cause of vocal cord palsy (VCP) is idiopathic impairment of the recurrent laryngeal nerve (RLN). However, solid tumors along the pathway of the RLN can also impact the nerve’s function. We presented a patient with a thyroid lesion and VCP due to a bulky metastatic mass (uterine cancer) on the aortic arch field in the mediastinum. The report aims to show the significance of comorbid tumors in thyroid pathology and the importance of additional diagnostic methods in avoiding unnecessary surgeries. A patient’s lifetime and the outcome of the disease were also presented.Case presentationA 58-year-old Ukrainian woman with a hoarse voice, intermittent dry cough, and weakness was presented to an endocrine surgeon. Thyroid pathology included signs of hypothyroidism treated with Thyroxine 112.5 µg and a nodule in the left lobe. The lesion is located on the posterior aspect of the lobe, which could probably be a cause of RLN involvement. Fine needle aspiration biopsy (FNAB) was performed twice with Bethesda category 2 result. Fibrolaryngoscopy (FLS) revealed the median position of the left vocal cord. Idiopathic, laryngeal, and thyroid causes of the VCP were excluded. Additionally, the patient displayed her anamnesis of the endometrial clear cell carcinoma following hysterectomy, external beam radiation therapy, and chemotherapy. The mediastinal metastasis was revealed sixteen years later. A chest computed tomography (CT) with intravenous contrast was done. A bulky tumor was found right under the aortic arch. Subsequently, the voice complaints reduced significantly after 4 chemotherapy courses. Cancer progression had led to the appearance of lymph node metastases on the supraclavicular region. Following six months the 60-year-old patient had passed away.ConclusionA history of the disease should always be kept in mind when assessing a patient’s complaints. VCP in case of thyroid pathology and previous secondary malignancy may be caused by metastatic tumor anywhere along the RLN pathway. Such a rare case shows the importance of additional methods of examination which may avoid unnecessary thyroid surgeries.

Animal study: Basic mechanism of vocal cord paralysis caused by button battery ingestion in children

PurposeVocal cord paralysis has been reported as a common complication of button battery (BB) ingestion, and there is a need to confirm the mechanism of vocal cord paralysis for the development of a standardized treatment. MethodsA new CR2032 BB and artificial saliva were placed in a fresh pig esophagus with the recurrent laryngeal nerve (RLN); the negative electrode faced the nerve in the experimental group, while the positive electrode faced the nerve in the control group. The pH values of the intra- and extraesophageal walls were measured simultaneously. Pathological examination was performed after the esophagus and nerves were damaged. ResultsAfter BB ingestion, the pH near the intraesophageal negative electrode increased rapidly, reaching 11.5 at 30 min and over 14 at 6 h, while the extraesophageal pH did not change at 1 h and began to accelerate after 2 h, reaching 10 at 6 h. After 6 h of exposure, the pathological section showed that the structure of the mucosa, submucosa, and muscle layer were destroyed; chromatin in the nucleus faded, and part of the nerve bundle in the adventitia had liquefaction necrosis. ConclusionThe basic mechanism of vocal cord paralysis caused by BB ingestion is that the OH− generated by the electrolytic reaction of the negative electrode penetrates the esophageal wall and corrodes the RLN, which may be the cause of vocal cord paralysis caused by BB ingestion without esophageal perforation.

When The Silence Prevails, Images Talk: The Characteristic Ct Features Of Vocal Cord Paralysis, Causes Of Missed Palsy By Radiologists And Mimics Of Vocal Cord Palsy Unveiled.

Causes of vocal cord palsy (VCP) can be identified even before its clinical presentation if a radiologist has knowledge about signs of vocal cord palsy, its various mimics and the anatomy of recurrent laryngeal nerve. Objectives are to know the signs and underlying causes leading to VCP and various mimics which may lead to the false positive diagnosis of VCP. A retrospective cross-sectional pilot study comprising 54 patients with vocal cord palsy proven by IDL was conducted. 3 groups were identified. The first group comprised missed VCP on cross-sectional imaging. The second group was, of missed cause of VCP in patients with clinical diagnoses. The third group was patients with mimics of the palsy. Thirteen (76.5%) patients had missed diagnosis due to lack of knowledge of signs and 23.5% due to lack of time, overwork and tiredness. A vigilant search for the cause was not done in 31.6% of patients and in 68.4% of patients, the cause was identified but not correlated. A total of 8 patients had false positive diagnoses due to failure to differentiate from mimics. There is an increasing trend of missed diagnosis of vocal cord palsy on cross-sectional imaging in patients with established clinical diagnosis due to a lack of knowledge of VCP signs and missed causes along the course of recurrent laryngeal nerve.

Systematic Evaluation of Vocal Cord Function is Critical for Thyroid Cancer Patients: A Patient of Left Papillary Thyroid Carcinoma with Left Vocal Cord Paralysis

Temporary or permanent vocal cord paralysis caused by recurrent laryngeal nerve injury is one of the relatively common and serious complications of thyroid surgery. At the same time, there are many reasons for recurrent laryngeal nerve injury. Therefore, the recurrent laryngeal nerve should be paid attention to before, during and after thyroid surgery. A 51-year-old woman was diagnosed with left papillary thyroid carcinoma. Unfortunately, the patient had a history of hoarseness following a patent ductus arteriosus ligation. We operated on her for thyroid cancer. Preoperative electronic laryngoscopy revealed paralysis of the left vocal cord, and intraoperative nerve monitor showed no signal of the left vagus nerve and recurrent laryngeal nerve. There was no improvement in hoarseness symptoms during postoperative follow-up three months. There are many causes of vocal cord paralysis. In addition to the central injury, any nerve injury of vagus nerve from the brainstem nucleus suspicius to the laryngeal muscle pathway it innervates can cause vocal cord paralysis. Paying attention to the recurrent laryngeal nerve before, during and after surgery can effectively reduce the vocalization of recurrent laryngeal nerve injury.

Comparison of the Voice Outcome After Injection Laryngoplasty: Unilateral Vocal Fold Paralysis Due to Cancer Nerve Invasion and Iatrogenic Injury

Background and Objectives Injection laryngoplasty is a common method for treatment of unilateral vocal fold paralysis. Unilateral vocal fold paralysis has various causes, including idiopathic, infection, stroke, neurologic condition, surgery and nerve invasion by cancer. To the knowledge of the authors, there was no study on the relationship between the causes of vocal cord paralysis and the outcome of injection laryngoplasty. Therefore, we tried to investigate the difference in the outcomes of injection laryngoplasty between vocal cord paralysis after surgery group and nerve invasion by cancer group.Materials and Method A retrospective analysis was performed for 24 patients who underwent vocal cord injection due to unilateral vocal cord paralysis caused by surgery or nerve invasion by cancer. The objective quality of the voice was assessed by acoustic voice analysis with the Multi-Dimensional Voice Program.Results Both group showed an improvement of fundamental frequemcy (F0), jitter percent, shimmer (percent), and noise to hearmonic ratio (NHR) after injection laryngoplasty. The vocal cord paralysis due to nerve invasion group showed more improvement in both the mean and median value of F0, shimmer percent and NHR than the vocal cord paralysis due to surgery group, but there was not statistically significant.Conclusion Our study did not show a statistically significant difference in outcome between vocal cord paralysis due to cancer invasion group and surgery group, but statistically tendency was suggested. The vocal cord paralysis due to nerve invasion group showed more improvement in both the mean and median value of acoustic voice analysis than surgery group.

Extralaryngeal causes of unilateral vocal cord paralysis: Aetiology and prognosis

Introduction and methodologyUnilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases of the thorax, neck, skull, or systemic disease. The objective is to study the extralaryngeal aetiology of unilateral vocal cord paralysis, its prognosis, and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT ± evaluation by Neurology with brain MRI to establish the aetiology and were followed-up for at least 1 year. ResultsThe most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumour (24.1%). Idiopathic paralysis was the cause in 15.5%. An association was obtained between sex and aetiology (P < .01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumour and idiopathic aetiology predominated in elderly patients; while surgical aetiology predominated in younger patients (P < .01). A total of 18.1% recovered vocal cord mobility. The female sex was related to recovery (P < .01). Tobacco and malignant aetiology were related to persistence (P < .01). ConclusionsThe first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause the condition, in many cases involving a diagnosis of malignant tumours. Recovery is more frequent in female patients, non-smokers and with benign pathology.

Vocal Cord Paralysis Secondary to Carotid Artery Dissection: A Case Report

Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.

Ultrasound of the vocal cords in infants.

Vocal cord paralysis is a common cause of respiratory and feeding problems in the pediatric population. While the causes of vocal cord paralysis are multiple, iatrogenic injury of the recurrent laryngeal nerve after cardiovascular surgery is the most frequent cause. Vocal cord paralysis increases the risk of swallowing dysfunction, tracheal aspiration and pneumonia. It also increases the need for nasoenteric feeds and gastrostomy tube placement. Flexible nasopharyngolaryngoscopy is considered the gold standard for diagnosing vocal cord paralysis, but it has significant drawbacks: it is uncomfortable, it can trigger a cardiovascular event in children with unstable cardiovascular status, it can be challenging to perform, and it can be difficult to interpret. Laryngeal US has become a popular imaging modality to evaluate the function of the vocal cords. Laryngeal US is well-tolerated, easy to perform, simple to interpret and has a lower physiological impact compared to flexible nasopharyngolaryngoscopy. Laryngeal US is an accurate and low-cost diagnostic test for vocal cord paralysis. In this review, we describe the anatomy of the larynx and recurrent laryngeal nerve; the causes, symptoms and pathophysiology of vocal cord paralysis; laryngeal US technique; diagnostic criteria for vocal cord paralysis; and a reporting system.

A Case Report: Probably Concurrent Nasogastric Tube Syndrome and Cerebrovascular Disease in a Postoperative Patient

Nasogastric tube syndrome (NTS) is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. Although NTS is a rare cause of vocal cord paralysis, it has the potential of causing serious morbidities even mortality. We here with present a case of concurrent NTS and cerebrovascular disease patient. 73 year-old male was admitted to our university hospital emergency department with acute respiratory distress and stridor days after his cholecystectomy operation and laryngoscopy showed bilateral vocal cord paralysis. The patient was admitted to the intensive care unit (ICU) and urgent tracheotomy was performed. On the day after his discharge from the hospital, his vocal cord movements fully recovered state. Nasogastric tube syndrome can be considered in patient who complains because of acute upper airway obstruction with nasogastric tube inserted. Thinking NTS early may be reducing the complication rate.

CLINICO-ETIOLOGICAL SKETCH OF VOCAL CORD PALSY

OBJECTIVE: To determine clinical features and causesof vocal cord paralysis in our set up.MATERIALAND METHODS: This descriptive study was conducted in the department of ENT, Head &amp;Neck Surgery, Hayat Abad Medical complex, Peshawar from January 2010 to December 2012. All newlydiagnosed patients of any age and either gender included. After enrollment a detailed history was taken,thorough ENT and systemic examination was conducted especially focusing on the causes of vocal cordpalsy. After routine investigation endoscopic examination of the upper aero-digestive tract was carried outto establish the diagnosis and causes of vocal cord paralysis.All these patients were followed regularly.Thedata was collected on a pre-designed proforma and analyzed using SPSS version 15.RESULTS: We studied 90 patients over a period of 3 years (2010-2012). Males outnumbered (n-60) withmale to female ratio of 2:1. These patients were in age range of 6-85 years with mean age of 47.33 ± SD21.15 years. The commonest presentation was change of voice (100%). Majority of the patients (n-52,57.77%) were non smoker. Hoarseness was the dominant (94.44%) presentation of these patients. Thecommonest causes of vocal cord palsy was idiopathic (34.44%) followed by thyroid surgery (21.11%). Leftvocal cord palsy was the commonest finding.CONCLUSION: We concluded from this study that vocal cord paralysis is still a challenge for ENTsurgeon. Although in our study idiopathic cause of vocal cord palsy was on top but thyroidectomy has greatcontribution to vocal cord paralysis which can be further minimized if surgeon gives some time to identifythe recurrent laryngeal nerve during thyroid surgery.KEY WORDS: Vocal cord palsy, vocal fold paralysis, hoarseness, clinical feature, etiology

Cardio-vocal Syndrome as a Complication Patient with Severe Mitral Regurgitation and Moderate Aortic Regurgitation with Pulmonary Hypertension

ABSTRACT Hoarseness due to paralysis of vocal cord, as in Cardio-vocal syndrome, is caused by mechanical affection of left recurrent laryngeal nerve from enlarged cardiovascular structures. Mitral valve prolapse is rarely found to cause this syndrome. Case report presenting a 47 years old male visited the outpatient department with a clinical history of dyspnea and hoarseness since a year ago. Physical examination revealed late systolic murmur in apex and low-grade diastolic murmur in right second intercostal space. Echocardiography confirmed severe mitral regurgitation due to flail anterior mitral valve leaflet with severe left atrium dilatation (9.0 cm) and moderate aortic regurgitation due to mal-coaptation of aortic valves. Laryngoscopy revealed an immobile left vocal cord. He underwent successful double valve replacement after three months follow up the patient showed improvement of hoarseness. The incidence of Cardio-vocal syndrome in mitral valve disease varies from 0.6% to 5%. In cases diagnosed with thoracic disease, paralysis of the left vocal cord was reported 1.75 times more frequent than the right side. The aim of this case report is we have to aware that Cardio-vocal syndrome is a rare cause of vocal cord paralysis and should be considered as a differential diagnosis of hoarseness, particularly if the patient has a cardiac history. Comprehensive evaluation and prompt treatment may allow reversal of the damage to left recurrent laryngeal nerve. Permanent nerve damage can occur due to late diagnosis. Keywords : Cardio-vocal syndrome, Mitral regurgitation, Aortic RegurgitationCorrespondence : adityobasworo@gmail.com

Extracranial internal carotid artery tortuosity may cause vocal cord palsy

Background: Clinical practice made us suspect that vocal cord palsy (VCP) can be associated with extracranial internal carotid artery (ICA) tortuosity.Objectives: To find evidence for a causative relation between ICA tortuosity and VCP.Methods: This single-center, retrospective study comprised 66 patients with VCP. A total of 45 patients without VCP served as control group. Patient charts were reviewed for etiology and side of VCP. CT scans were reviewed independently by two radiologists for imprint in the jugular vein (JV) caused by a tortuous ICA, considered an indirect sign of potential vagus nerve affection.Results: A total of 33 patients had idiopathic VCP. ICA tortuosity causing a JV imprint with >10% JV lumen reduction was found more frequently on the paretic sides of patients with idiopathic VCP (15–24%) than in controls (3–9%), with p<.05 for observer 2 and p=.07 for observer 1. In patients with idiopathic VCP and JV imprint with >10% JV lumen reduction on one or both sides (n = 9), both observers found JV imprint with >10% JV lumen reduction more frequently on the side of VCP (p<.05).Conclusions: ICA tortuosity causing a JV imprint may be the cause of VCP in some of the cases of VCP currently regarded as idiopathic.

Vocal cord paralysis as primary and secondary results of malignancy. A prospective descriptive study.

ObjectiveVocal cord paralysis (VCP) may be caused by a primary malignancy and associated immune cross‐reactivity. We aimed to illuminate underlying causes of VCP and to assess if onconeural antibodies occur in association to VCP as an early predictor of cancer.MethodsA prospective study was performed in patients with newly diagnosed VCP from 2014 to 2016. All patients underwent fiberoptic laryngoscopy, ultrasound of the neck and computed tomography (CT) of the neck and thorax. Patients with idiopathic VCP underwent neurological examination, positron emission tomography/CT, and serum analysis for onconeural antibodies. All patients were offered a one‐year clinical follow‐up.ResultsIn total 53 patients fulfilled the inclusion criteria. Left VCP occurred in 37 (70%), right in 15 (28%), and bilateral in one patient (2%). The cause of VCP was cancer in 27 (51%) patients, of those 15 (56%) had VCP as the primary symptom, including all cases with laryngeal and esophageal cancer. Median time interval between VCP and cancer was 7 days (range 1–30). In 12 (23%) VCP was a secondary symptom. Lung cancer was the most common etiology, 14 of 27 (52%), 12 patients (86%) with non‐small cell lung cancer. Idiopathic VCP was diagnosed in 18 (34%) patients, of those nine patients had a neurological examination and were screened for well‐known onconeural antibodies, which were not detected. Reactions against Purkinje cell nuclei were seen in three patients, none showed symptoms or signs of cancer at follow‐up.ConclusionsThe causes of VCP were described. VCP was frequently the primary symptom, and also occurred as a secondary symptom of cancer. Exclusion of malignancy is important in patients with VCP.Level of Evidence1b

Diagnostic difficulties in children with iatrogenic vocal cord paralysis in the material of the Department of Pediatric Otolaryngology of the Medical University of Warsaw

Introduction. The causes of vocal cord paralysis in children include congenital malformations, nervous system disorders, and iatrogenic causes. The paralysis may affect one or both cords. The signs of bilateral vocal cord paralysis include respiratory stridor of varying severity, and even acute respiratory failure. The signs and symptoms of unilateral vocal cord paralysis include phonation and swallowing disorders, as well as respiratory stridor associated with partial stenosis of already physiologically narrow airways in children. Diagnosing the cause for vocal cord paralysis in children is difficult. Aim. The aim of the study was to analyze the causes of iatrogenic vocal cord paralysis, as well as to assess the usefulness of diagnostic methods used in children with iatrogenic vocal chords paralysis. Material and methods. A retrospective analysis of clinical data of 20 children with iatrogenic vocal cord paralysis under the care of the Department of Pediatric Otolaryngology of the Medical University of Warsaw in 2017 was conducted. Results. The study group included 13 boys and 7 girls aged from 1 month of age to 10 years of age; median age at the diagnosis was 3 months. In 17 children, bilateral paralysis was diagnosed, and 3 children were diagnosed with unilateral paralysis. The cause of iatrogenic vocal cord paralysis in 7 children was cardiac surgery, in 1 ? thoracic surgery, in 7 ? prolonged intubation, in 3 ? perinatal hypoxia, and in 2 ? vincristine chemotherapy. Conclusions. The diagnosis of iatrogenic vocal cord paralysis is difficult. The applied diagnostic methods require an integrated interpretation. The larynx ultrasound (US) examination remains very useful in the assessment of the vocal cords mobility in children, however, it is not possible to perform this examination in intubated patients. Fiberoscopy, performed under local anesthesia, is widely available, however, performing it on a narrow larynx of a child may cause respiratory disorders. US and fiberoscopy in infants should be supplemented by direct laryngoscopy in order to exclude congenital airway defects that may have symptoms similar to them. In any case, neurological disorders and genetic defects causing vocal cord paralysis must be excluded.

가역적 성대마비의 원인이 된 비활성 부갑상선 선종 1예

Parathyroid adenoma is the most common cause of primary hyperparathyroidism with symptoms of fatigue, bone pain, abdominal pain, weakness, dyspepsia, and skeletal bone disease. However, vocal cord paralysis caused by parathyroid adenoma is extremely rare. A 72-year-old male presented with intermittent voice change for 10 years. Laryngeal endoscopy showed right vocal cord paralysis. Computed tomography revealed a 4 mm sized lesion behind of right thyroid. Fine needle aspiration was undertaken and the histology result was a parathyroid adenoma. We excised the parathyroid adenoma adjacent to the right recurrent laryngeal nerve. After excision of parathyroid adenoma, vocal cord paralysis has returned to normal. The patient is under observation for 6 months without recurrence. We report our experience of one rare case of parathyroid adenoma as a cause of vocal cord paralysis. (J Clinical Otolaryngol 2016;27:401-404)

Manifestaciones en imagen y causas de las parálisis del nervio laríngeo recurrente

The vocal cords play a key role in the functions of the larynx. Their motor innervation depends on the recurrent laryngeal nerve (a branch of the tenth cranial nerve), which follows a long trajectory comprising intracranial, cervical, and mediastinal segments. Vocal cord paralysis usually manifests as dysphonia, the main symptom calling for CT study, the first-line imaging test to investigate the cause of the lesion. Patients are asymptomatic in a third of cases, so the incidental detection of signs of vocal cord paralysis in a CT study done for other reasons should prompt a search for a potentially severe occult lesion. This article aims to familiarize readers with the anatomy of the motor innervation of the glottis, the radiological presentation and most common causes of vocal cord paralysis, and conditions that can simulate vocal cord paralysis.

An Overview of Laryngeal Muscle Single Fiber Electromyography.

Needle electromyography is an important tool in the diagnosis of neuromuscular diseases and has also been applied successfully in the evaluation of the vocal cord paralysis. Laryngeal electromyography, initially described by Weddell, is used to determine the cause of vocal cord paralysis and to differentiate organic from nonorganic causes of speech disorders. This test allows the diagnosis of lower motor neuron and nerve paralysis as well as myopathies. Laryngeal electromyography also helps to determine the prognosis of paralysis caused by traumatic injury of the laryngeal nerves and is used for guidance during botulinum toxin injection in spasmodic dysphonias. Single fiber electromyography is used to diagnose abnormalities of neuromuscular transmission and is applied in the study the architecture of the motor unit in muscles. This article reviews the techniques of laryngeal muscles single fiber electromyography, provides limited informative data, and discusses its potential value in the evaluation of patients with dysphonia.

Bilateral vocal cord paralysis following coronary artery bypass surgery.

Bilateral vocal cord paralysis following coronary artery bypass surgery.

Index of Suspicion in the Nursery

A term male infant is transferred to the NICU for persistent hypoglycemia at age 3.5 hours. The infant had a blood sugar level of 21 mg/dL at age 3 hours and despite refeeding 20 mL of 20 calories per ounce of formula, his blood glucose level remained at 20 mg/dL at 3.5 hours. The infant was born via cesarean delivery for a nonreassuring heart rate tracing to a 19-year-old G1P 0 African-American mother. All prenatal laboratory results were negative, including an oral glucose tolerance test. Prenatal ultrasonography was performed during the second trimester and showed no gross fetal anomalies other than the presence of a two-vessel cord. The infant cried spontaneously at birth and had some transient respiratory distress. The infant weighs 2,960 g (50th percentile) with a length of 48 cm (50th percentile) and a head circumference of 32.5 cm (25th–50th percentile). Results of the physical examination are normal except for a small penis (stretched penile length of 1.5 cm, width of 0.6 cm) and an undescended left testicle. Blood glucose levels below 40 mg/dL persist despite two boluses of 10% dextrose and administration of continuous dextrose infusion with a glucose infusion rate of ∼5 mg/kg per minute. Glucose levels above 40 mg/dL are eventually achieved with a glucose infusion rate of 8 mg/kg per minute. The pediatric endocrinology service was consulted on the second day for persistent hypoglycemia. A 3,490-g term male infant is born to a 20-year-old primigravida mother. She received good prenatal care, and her pregnancy was uncomplicated. Antenatal screening for human immunodeficiency virus, hepatitis B, and syphilis were negative, and she had immunity against rubella. Results of the patient’s cervical culture were positive for group B streptococcus, but she received adequate intrapartum penicillin prophylaxis before delivery. There was no abnormality noted on the fetal cardiotocography. …

CT Evaluation of Vocal Cord Paralysis due to Thoracic Diseases: A 10-Year Retrospective Study

PurposeTo discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases.Materials and MethodsFrom records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy.ResultsThirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP.ConclusionCT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.