Vocal cord paresis on CTA - A novel tool for the diagnosis of lateral medullary syndrome

Prolonged endotracheal intubation in the adult is becoming more popular with the advent of “soft” tubes and cuffs. The many deleterious effects of such long-term intubation on the laryngotrachea have been extensively discussed in the literature. However, only sporatic attention has been given to vocal cord paresis or paralysis. The University of Cincinnati Medical Center experience with postintubation patients has shown that cord mobility disturbances are relatively common. Sixteen patients are presented who have had similar clinical findings and course following extubation. The clinical picture is that of a symmetrical vocal cord paresis or paralysis associated with arytenoid and posterior commissure edema and erythema. Vocal cord position is most often median or paramedian. A spontaneous recovery over days to weeks is the usual course. During the recovery phase cord movement most often remains symmetrical; however, full motion may occur in one cord before the other. In all patients abduction was most limited and slowest to return. In this series the most significant effect has been aspiration. Two patients developed a posterior commissure stenosis. This entity is believed to be due to inflammation initiated by the tube and its movement against the posterior half of the endolarynx. In particular, inflammatory involvement of the cricoarytenoid joints and interarytenoid region best explain the clinical course. When mucosal ulcerations and granulation tissue are superimposed on the immobilized cords interarytenoid scarring may lead to chronic stenosis.

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Early-onset severe axonal neuropathy associated with optic atrophy and vocal cord paresis due to a mitofusin 2 mutation

Clinical Neurophysiology ◽

10.1016/j.clinph.2007.10.036 ◽

2008 ◽

Vol 119 (3) ◽

pp. e20

Author(s):

Eppie M. Yiu ◽

Lloyd K. Shield ◽

Leslie J. Roberts ◽

Desirée du Sart ◽

Belinda Chong ◽

...

Keyword(s):

Vocal Cord ◽

Optic Atrophy ◽

Early Onset ◽

Axonal Neuropathy ◽

Mitofusin 2 ◽

Vocal Cord Paresis

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Bilateral Vocal Cord Paralysis with Shy-Drager Syndrome

Otolaryngology ◽

10.1177/019459989310900521 ◽

1993 ◽

Vol 109 (5) ◽

pp. 911-914 ◽

Cited By ~ 9

Author(s):

Rohit Bawa ◽

Hassan H. Ramadan ◽

Stephen J. Wetmore

Keyword(s):

Orthostatic Hypotension ◽

Vocal Cord ◽

Vocal Cord Paralysis ◽

English Literature ◽

System Failure ◽

Bilateral Vocal Cord Paralysis ◽

Vocal Cord Paresis ◽

Median Position ◽

History Of ◽

Emergency Tracheotomy

Shy-Drager syndrome consists of progressive autonomic nervous system failure with Parkinson's disease-like symptoms and orthostatic hypotension. It can also result in airway compromise from bilateral vocal cord paralysis. Fewer than 30 cases of severe bilateral vocal cord paresis or paralysis associated with the Shy-Drager syndrome have been reported in the English literature. We present a case of a 72-year-old man who had a 2-year history of orthostatic hypotension, neurogenic bladder, impotence, anhydrosis, and extremity weakness and paresthesias. Hoarseness and dyspnea with stridor developed as a result of bilateral vocal cord paralysis in the median position and required an emergency tracheotomy. This combination of symptoms resulted in the diagnosis of Shy-Drager syndrome. We present the case along with literature review of bilateral vocal cord paralysis with the Shy-Drager syndrome.

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