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Vocal Cord ParalysisAka: Laryngeal Nerve Palsy, Laryngeal Paralysis

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  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
    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. Arsenic poisoning
        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

Laryngeal Paralysis (C0086523)

ConceptsDisease or Syndrome (T047)
ICD9478.30
EnglishLaryngeal Paralyses, Laryngeal Paralysis, LARYNGOPARALYSIS, Laryngoplegia, Larynx paralysis, Paralysis of larynx, Paralysis of larynx unspecified
Spanishlaringoplejia, paralisis de la laringe, paralisis de laringe no especificada, paralisis laringea
Parent ConceptsLaryngeal Diseases (C0023051), Vocal Cord Paralysis (C0042928)
SourcesCST, MSH, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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