Otolaryngology Book

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Vocal Cord Paralysis

Aka: Vocal Cord Paralysis, Laryngeal Nerve Palsy, Laryngeal Paralysis
  1. See Also
    1. Hoarseness
  2. Causes of Unilateral Vocal Cord Paralysis
    1. Tumor
    2. Medications
      1. Vincristine
      2. Phenytoin
        1. Fried (1975) Laryngoscope 85:1770-81
    3. Inflammation or Infection
      1. Collagen vascular disease
      2. Lyme Disease
      3. Mononucleosis
      4. Sarcoidosis
    4. Toxic and Metabolic Causes
      1. Diabetes Mellitus
      2. Alcoholism
      3. Heavy metal exposure
        1. ArsenicPoisoning
        2. Mercury Poisoning
        3. Lead Poisoning
    5. Trauma
      1. Intubation
      2. Post-surgical
        1. Carotid surgery
        2. Neck dissection for head and neck cancer
        3. Cardiac surgery
          1. Patent Ductus Arteriosus ligation (newborns)
          2. Valve repair
        4. Thyroid surgery
        5. Tracheal surgery
  3. Symptoms
    1. Hoarseness
    2. Decreased endurance for speech and voice Fatigue
    3. Swallowing difficulty or Choking on liquids
    4. Singing difficulty
  4. Signs: Laryngoscopy
    1. Paralyzed vocal cord is fixed in paramedian position
      1. Just lateral to midline
      2. Slight adduction may be seen (collateral innervation)
    2. Paralyzed vocal cord is bowed and flaccid
      1. When speaking, drops lower than the unaffected cord
    3. Uninvolved vocal fold may compensate
      1. Uninvolved cord crosses midline over next 2-3 months
      2. Meets paralyzed cord
  5. Evaluation
    1. See Speech Exam
    2. Careful lymph node examination
      1. See Lymphadenopathy of the Head and Neck
  6. Radiology
    1. Chest XRay (consider lordotic views)
  7. Management: General
    1. Laryngology or ENT referral in most cases
    2. Early speech pathology for voice building Exercises
  8. Management: Surgery for unilaterally paralyzed vocal cord
    1. Medialization Laryngoplasty (Thyroplasty) with implant
      1. Various implant types (e.g. Gore-Tex, Silicon)
    2. Medialization via office injection
      1. Collagen injections
      2. Avoid Teflon augmentation due to granulation
    3. Reinnervation
      1. Requires more time to result than other procedures
  9. Complications
    1. Aspiration of food contents
  10. Resources
    1. Voice Doctor Website (Dr. Thomas)
      1. http://www.voicedoctor.net/diagnose/sx/urln.htm
  11. References
    1. Rosen (1998) Am Fam Physician 57(11): 2775-2782

Laryngeal Paralysis (C0086523)

Concepts Disease or Syndrome (T047)
MSH D014826
ICD10 J38.0
SnomedCT 195846000, 266349000, 89927005, 195840006, 195841005
English Larynx paralysis, Laryngeal Paralyses, Paralyses, Laryngeal, Paralysis, Laryngeal, LARYNGOPARALYSIS, Laryngoplegia, NOS, Paralysis of larynx, NOS, Laryngoplegia NOS, Paralysis of larynx unspec., Paralysis of larynx unspecified, Laryngoparalysis, Paralysis of larynx unspecified (disorder), Laryngoplegia NOS (disorder), laryngeal paralysis, larynx paralysis, paralysis larynx, Laryngoplegia, Paralysis of larynx (disorder), Paralysis of larynx, laryngoplegia, larynx; paralysis, paralysis; larynx, Laryngeal paralysis, Laryngeal Paralysis
Portuguese PARALISIA LARINGEA, Paralisia laríngea, Paralisia Laríngea
Spanish PARALISIS LARINGEA, Laringoparálisis, Laryngoplegia, Laryngeal paralysis, Larynx paralysis, Paralisis Laringea, Parálisis Laríngea, laringoplejía, SAI (trastorno), laringoplejía, SAI, laringoplejía, parálisis de la laringe (trastorno), parálisis de la laringe, parálisis de laringe no especificada (trastorno), parálisis de laringe no especificada, parálisis laríngea
Dutch laryngoparalyse, larynx; paralyse, paralyse; larynx, Larynxparalyse
German Laryngoparalyse, Laryngealparalyse, KEHLKOPFLAEHMUNG
Italian Paralisi laringea
Japanese 喉頭麻痺, ｺｳﾄｳﾏﾋ
French Paralysie laryngée, PARALYSIE DES MUSCLES LARYNGES, Paralysie du larynx
Czech Paralýza laryngu
Croatian PARALIZA LARINKSA
Hungarian Gégeizom bénulás
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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