Presentation
We describe what appears to be the first case in the medical literature of sarcoidosis presenting as isolated, bilateral true vocal cord paralysis resulting from compressive bilateral mediastinal adenopathy. [ncbi.nlm.nih.gov]
Entire Body System
- Weakness
The delayed-type syndrome can produce muscle weakness for months. Our patient, a 2-year-old boy, was found eating a substance later found to be contaminated with insecticide. [ncbi.nlm.nih.gov]
The neurologic evaluation did not uncover any signs of ophthalmoplegia, ptosis, or facial muscle weakness, but the gag reflex was absent. [kjorl.org]
- Crying
These symptoms are due to the stationary but flaccid midline position of the vocal cords which places them in a phonating position, where they both obstruct the airway and produce a faily clear voice or cry. [ncbi.nlm.nih.gov]
The voice and cry are often normal. BVCP is diagnosed using a flexible endoscope through the child’s nose with the child awake. [stanfordchildrens.org]
Children with one-sided vocal cord paralysis may breathe noisily (stridor) occasionally rather than all the time, have a weak breathy cry or swallowing problems. [gosh.nhs.uk]
In infants, the cry can be weak. Older children will suppress laughing and coughing because it is hard to do. Swallowing may be hindered so that food ends up in the airway, causing violent coughing and often leading to pneumonia. [medical-dictionary.thefreedictionary.com]
The symptoms of unilateral paralysis include a hoarse cry and stridor on deep inspiration. Children with unilateral vocal cord paralysis will most commonly recover spontaneously or compensate. [czytelniamedyczna.pl]
- Inflammation
These are called idiopathic, and usually attributed to viral inflammation. These cannot technically be proven, and so it is important to understand that this is only an assumption. [voice.weill.cornell.edu]
Although the cord nerves are usually working correctly, the inflammation can give vocal cord paralysis-like signs and symptoms. Some infections may also cause inflammation. [medicalnewstoday.com]
One theory is that the common cold virus may cause nerve inflammation. [entnet.org]
[…] trauma, mediastinal and thoracic surgery, cardiovascular pathology, neurofibroma of parapharyngeal space, lymphoma, central nervous dysfunction, severe head injury, Arnold-Chiari malformation, multiple congenital anomalies, toxic and metabolic causes, inflammation [czytelniamedyczna.pl]
One patient required intravenous steroid therapy for delayed glottic inflammation that resolved without permanent sequelae. [aetna.com]
- Feeding Difficulties
Symptoms usually arise during infancy, and include feeding difficulty, inspiratory stridor (a high pitch noise when breathing in) and airway obstruction. The voice and cry are often normal. [stanfordchildrens.org]
Respiratoric
- Stridor
We report a case of bilateral vocal cord paralysis leading to significant stridor in a patient with atypical parkinsonism (probable MSA). [ncbi.nlm.nih.gov]
The most common presenting symptom in children who have bilateral VCP is stridor. Children who have bilateral VCP are more likely to present with stridor and dyspnea than with dysphonia and aspiration. [entokey.com]
- Aspiration
A 72-year-old woman with uveitis of the left eye complained of hoarseness and aspiration due to bilateral vocal cord paralysis. [ncbi.nlm.nih.gov]
None of the patients complained of aspiration postoperatively. [jhnps.org]
- Hoarseness
Hoarseness, however, is an initial symptom of ALS in only a small number of patients. We report a 43-year-old female with hoarseness due to bilateral vocal cord paralysis as the first manifestation of ALS. [ncbi.nlm.nih.gov]
A 72-year-old woman with uveitis of the left eye complained of hoarseness and aspiration due to bilateral vocal cord paralysis. [jstage.jst.go.jp]
- Dyspnea
Management of severe dyspnea caused by association of these two complications of thyroidectomy means a great therapeutic challenge. [ncbi.nlm.nih.gov]
- Respiratory Distress
We report a patient admitted with an exacerbation of achalasia who developed acute respiratory distress from bilateral immobile vocal cords. [ncbi.nlm.nih.gov]
Gastrointestinal
- Choking
Call your child’s doctor if your child struggles to swallow his / her food, coughs or chokes often when eating or is not gaining weight. [cincinnatichildrens.org]
Aspiration - because there is paralysis in the area where food or liquid may go down the wrong way (aspiration), there is a risk of choking. Aspiration can lead to severe pneumonia. [medicalnewstoday.com]
Sufferers may choke while eating or aspirate food into the lungs while trying to breathe through the limited airway, sometimes leading to pneumonia. [ent.uci.edu]
Patients may also complain of dysphagia or choking as glottic incompetence increases the risk of aspiration. [radiopaedia.org]
Because vocal cords serve an important function in keeping food and liquids out of our airway when we swallow, UVCP may lead to coughing and choking with feeding. This is more common with liquids, and can cause repetitive pneumonias. [stanfordchildrens.org]
- Nausea
Three months later, H.C complained of an episode of disequilibrium, along with associated symptoms of nausea and stridor. A direct fiberoptic laryngoscopy revealed bilateral vocal cord paralysis. [neurology.org]
Neurologic
- Stroke
In two patients with unilateral cortical stroke, bilateral vocal cord paralysis resulted in airway obstruction. Realization of this potential complication can lead to vigilant monitoring and early tracheostomy if needed. [ncbi.nlm.nih.gov]
Some of these include: Trauma Stroke Surgery, including spine, esophagus, or thyroid surgery Evaluation includes: Stroboscopic examination of the larynx Possible bronchoscopy Laryngeal EMG Treatment for bilateral fold paralysis is primarily aimed at enlarging [throatdisorder.com]
Bilateral paralysis is more likely than unilateral paralysis to be related to stroke or other neurological disease, so a brain scan may be useful as well. [voice.weill.cornell.edu]
[…] the larynx (voice box) may be damaged by a stroke Tumors: these may develop around or in the cartilages, nerves or muscles of the voice box. [medicalnewstoday.com]
This includes head and neck injuries, tumors, disease, surgery, or stroke. Testing for Vocal Fold Paralysis You should see your doctor if you have trouble with your voice. [asha.org]
- Asthenia
The voice was graded subjectively by a speech pathologist based on grade, roughness, breathiness, asthenia, strain (GRBAS) score Swallowing: Effect on deglutition was assessed by the presence or absence and duration of aspiration. [jhnps.org]
The GRBAS is used to rate the patient's voice quality on 5 dimensions: grade (overall severity), roughness, breathiness, asthenia (weakness) and strain. Each dimension will receive a severity rating from 0 (not present) to 3 (severe). [en.wikipedia.org]
Acoustic and perceptual parameters (overall grade of hoarseness, roughness, breathiness, asthenia, and strain), maximum phonation time, jitter, and shimmer, voice handicap index, and grades of mucosal waves and glottic closure were significantly improved [aetna.com]
- Tremor
Patients can struggle to manage a tracheostomy due to the tremor and bradykinesia associated with their parkinsonism. [ncbi.nlm.nih.gov]
Initial examination at the time revealed only decreased in sensation to light touch and pinprick below his knees bilaterally and a mild resting tremor in his right arm. [neurology.org]
We also treat voice disorders caused by neurological conditions, such as Parkinson’s disease, including vocal cord paralysis, spasmodic dysphonia, vocal tremors, and involuntary movements of the larynx, such as tics and myoclonus. [nyee.edu]
- Agitation
She also became agitated and breathless. The following day she was referred to the ENT department. On fibreoptic laryngoscopy examination both vocal cords were in the paramedian position with slight mobility. [jpma.org.pk]
Workup
On further workup he was diagnosed with hypothyroidism. Genetic workup supported the diagnosis of Williams-Beuren syndrome. We report here a case with an unusual clinical presentation. [ncbi.nlm.nih.gov]
In particular, this workup must include topical anesthesia to the larynx so as to enable an extremely close visualization of the posterior commissure and subglottis, which may uncover evidence of scarring. [laryngopedia.com]
Treatment
OBJECTIVE: To evaluate long-term results of surgical treatment for bilateral vocal cord paralysis using objective and subjective measures of breathing and voice quality. DESIGN: Prospective cross-sectional case series. [ncbi.nlm.nih.gov]
The detection of either would prompt the treatment of these underlying issues. It is possible that after treatment, paralysis of the vocal cords can resolve itself. [uciheadandneck.com]
Prognosis
[…] large subtorcular occipital encephalocele in neonate carries higher risk of associated hindbrain anomalies and secondary process for neurological deterioration which predict the surgical outcomes and long-term prognosis. [ncbi.nlm.nih.gov]
The prognosis and management of idiopathic vocal cord paralysis. Clinical Otolaryngology, 14 (3), 247-250. Woo, P. (2010). Stroboscopy. San Diego, EEUU: Plural Publishing. Woo, P., Colton, R., Brewer, D. & Casper, J. (1991). [revistas.iberoamericana.edu.co]
M. ( 1989 ) The prognosis and management of idiopathic vocal cord paralysis. Clinical Otolaryngology 14 : 247 – 250. Woodman D. ( 1946 ) A modification of the extralaryngeal approach to arytenoidectomy for bilateral abductor paralysis. [cambridge.org]
Etiology
There was no obvious cause for the paralysis and possible etiological factors are discussed. Overextension of the neck during intubation is suspected of being the etiological agent causing stretching of both the vagus nerves. [ncbi.nlm.nih.gov]
Etiology The etiology of BVFI in the study population, in decreasing order of incidence, included thyroid disease or associated surgery, intubation-related injury, congenital, central neurological disorders, autoimmune disease, and surgery or cancer of [journalotohns.biomedcentral.com]
Epidemiology
Post-surgical intervention is warranted to restore laryngeal muscle strength, agility and coordination. [20] Epidemiology [ edit ] Due to the complex and controversial nature of this condition, [3] epidemiological (incidence) reports vary significantly [en.wikipedia.org]
Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014 Jun;59(6):895–915. 14. Newman MH, Work WP. Arytenoidectomy revisited. Laryngoscope. 1976 Jun;86(6):840–9. 15. Woodman D. [e-ceo.org]
Pathophysiology
However, the pathophysiology of CBVCP is unknown and further investigations into the etiology of Moebius syndrome are required. [ncbi.nlm.nih.gov]
Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi J Anaesthesia [Internet]. 2011; 5: 308-13. Krodel DJ, Bittner E a, Abdulnour R-EE, Brown RH, Eikermann M. [revistas.asoneumocito.org]
Reisert PM (1996) Pathophysiology and clinical aspects of myxedema. Z Lymphol 20:6–10 PubMed Google Scholar 26. Lichtenberger G (2007) A new ligature-suture technique and instrument to control difficult pharyngeal and laryngeal hemorrhage. [link.springer.com]
Pathophysiology Although a comprehensive discussion of each of the causes is beyond the scope of this article, some principles should be emphasized. [emedicine.medscape.com]
Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol 1991; 100 (Pt 1):717-721. 8. Laccourreye O, Escovar M, Gerhardt J, et al. [ejo.eg.net]
Prevention
Early decompression may prevent permanent recurrent laryngeal nerve injury and airway obstruction. [ncbi.nlm.nih.gov]