Metabolic stridor: bilateral vocal cord abductor paralysis secondary to hypokalaemia?

A previously unreported association between bilateral abductor paralysis and hypokalaemia is reported in a patient presenting with stridor. Both the stridor and the bilateral abductor paralysis gradually resolved as the serum potassium was corrected. A casual link is suggested though the mechanism is unclear.     

Central vocal cord paralysis and paresis presenting as laryngeal stridor in children

Vocal cord paralysis or paresis as the initial presenting symptom for intracranial tumors in children are rare. Recently, two pediatric patients who were later diagnosed as having intracranial tumors presented with the symptom of voice changes and stridor. Telescopic examination revealed bilateral vocal cord paresis and paralysis as demonstrated by video recordings. The majority of pediatric brain tumors present with both generalized and localized complaints; however, by discussing these two rare cases, we hope to underscore the importance of a thorough workup of the paralyzed or paretic vocal cords.     

Adult chiari malformation presenting as bilateral vocal cord paralysis

In the Chiari malformations, herniation of the cerebellar tonsils through the foramen magnum into the cervical spinal canal can often result in headaches and spinal cord deficits. Bilateral vocal cord paralysis has been reported as a result of Chiari malformation but is rare and the vast majority of reports have been in the paediatric population. We report a case in a 68-year-old man with adult Chiari malformation where aspiration pneumonia from bilateral vocal cord palsy was the only manifestation of this malformation.     

Neuromuscular disorders presenting as congenital bilateral vocal cord paralysis

Congenital bilateral vocal cord paralysis (BVCP) can be associated with an underlying neuromuscular disorder, and may present before other features of the neuromuscular disorder become apparent. All infants less than 12 months of age presenting with BVCP between July 1987 and July 1999 at the Royal Children's Hospital, Melbourne, in whom a neuromuscular disorder was subsequently diagnosed were followed. Three children in whom BVCP was diagnosed soon after birth and before recognition of an underlying neuromuscular disorder were identified. All presented with upper airway obstructive symptoms at birth, had a diagnosis of bilateral abductor vocal cord paralysis made at awake flexible laryngoscopy, and had no underlying structural laryngeal abnormality on microlaryngoscopy and bronchoscopy. Two children required a tracheostomy, and 1 child was weaned from nasopharyngeal continuous positive airway pressure after 3 weeks. Subsequent neuromuscular symptoms were recognized between 4 months and 7 years later, leading to diagnoses of facioscapulohumeral myopathy, spinal muscular atrophy, and congenital myasthenia gravis. In each case, the prognosis for recovery from symptoms related to BVCP reflected that of the underlying neuromuscular disorder. This experience suggests that congenital BVCP may be a feature of an unrecognized neuromuscular condition. This possibility should be considered particularly in the presence of associated neurodevelopmental or neuromuscular dysfunction, or in cases in which BVCP is progressive.     

Acute stridor due to bilateral vocal fold paralysis as a presenting sign of myasthenia gravis.

We describe a case of myasthenia gravis in a 46-year-old man presenting as acute stridor with bilateral abductor paralysis of the vocal folds. Prompt diagnosis and medical treatment with pyridostigmine avoided the need for tracheostomy. It is important to remember the possibility of myasthenia gravis in cases of stridor due to bilateral vocal fold paralysis, since effective medical treatment is available.     

Nerve/muscle pedicle graft for bilateral vocal cord palsy

The nerve-muscle pedicle graft was successfully used in six of the seven patients admitted with bilateral vocal cord palsy. The diagnostic evaluation included bilateral vocal cord palsy for more than six months; passive mobility test of the arytenoids under general anaesthesia; and exclusion of an organic lesion as a cause of the vocal cord paralysis. The post-operative assessment was done by indirect or direct laryngoscopy. An improvement in phonation and respiration was noted 4 to 10 weeks after the operation. An exertional test was performed. Identification of the origin of ansa cervicalis from the hypoglossal nerve facilitated the operation.     

Kearns-Sayre syndrome: presenting with vocal fold palsy.

We present the first documented case of Kearns-Sayre syndrome presenting with a vocal fold palsy.     

Hereditary vocal cord palsy

Hereditary vocal cord palsy is an uncommon cause of neonatal stridor that has significant implications for patients, their families, and their future progeny.     

Neuralgic amyotrophy presenting with bilateral vocal cord paralysis in a child: a case report.

Acute stridor and bilateral vocal cord paralysis is not uncommon in the neonate but is unusual in the older child. We report the first case of bilateral vocal cord paralysis secondary to neuralgic amyotrophy, a peripheral polyneuropathy, in a 5-year-old child. An extensive workup revealed a paralyzed right hemidiaphragm, arm weakness and an EMG pattern consistent with neuralgic amyotrophy. Neuralgic amyotrophy is an uncommon disorder in pediatric patients which may involve cranial and peripheral nerves including the phrenic nerves and rarely the recurrent laryngeal nerves. We propose that the diagnosis be considered in children who present with bilateral vocal cord paralysis and other associated neurologic findings.     

Syringomyelia and bilateral vocal fold palsy

This is a case of a 35-year-old who had complained of noisy breathing for 15 years, and had been on treatment for 'chronic asthma'. She presented to the Accident and Emergency department with an acute episode of difficulty with breathing, and on admission was found to have stridor and bilateral abductor vocal fold palsy. Further workup revealed a syringomyelia with an associated Chiari type 1 malformation. It is important to consider the above diagnosis in the differential of young adults with breathing difficulties. A discussion of syringomyelia, Chiai malformations and bilateral vocal fold palsy follows.     

Relapsing polychondritis. Apropos of 4 cases

More than three hundred and fifty cases of this ailment can be counted at the present time, an ailment coming into the wide framework of connective tissue diseases with systemic vasculitis. The auricle chondritis remains the most frequent initial localization and its almost constant throughout development. The nasal chondritis is distinguished by its evolution to the saddle-nose deformity. The tracheo-bronchial localization remains the most severe one because of a risk of stenosis. During an evolution made by bouts, the disease also involves rheumatoid, ocular, audio-vestibular, dermatological and renal symptoms. Though an immunologic mechanism seems to be the origin of the disease, the pathogenesis of polychondritis is still mysterious. The polychondritis treatment is based upon systemic steroids therapy and possibly upon immunosuppressive agents as well. Dapsone, recently brought into the polychondritis treatment have not superseded cortico-steroid therapy.     

Paradoxical vocal cord motion: An important cause of stridor

Paradoxical vocal cord motion (PVCM) is an important cause of laryngeal stridor and dysphonia; however, only two previous cases have been reported. We report three additional cases, one of which was tracheotomized on two occasions before the diagnosis was made. These patients, typically young females who have had a recent upper respiratory infection, present with stridor. They can phonate weakly, but they cannot cough. Indirect laryngoscopy reveals smooth, symmetric vocal cord adduction on inspiration and abduction on expiration. Laboratory values are normal. PVCM appears to be self-limited (up to 72 hours), and patients respond to supportive care and sedation. Tracheotomy appears to be unnecessary. The etiology is obscure and may be functional; however, a case is discussed in which PVCM was seen in association with chronic aspiration in a patient with organic brain syndrome. An awareness of this entity and a high index of suspicion can prevent unnecessary tracheotomy.     

Paradoxical vocal cord motion: an unusual cause of stridor

Stridor due to obstructive causes is relatively common. Functional airway obstruction with paradoxical vocal cord motion is uncommon. Only 12 cases have been reported in the literature in the past 15 years. The majority were young female patients. We have recently encountered two cases. Lack of awareness of this condition caused several problems in management.     

低温等离子单侧声带离断并同侧杓状软骨切除术治疗双侧声带外展麻痹

目的 探讨在内镜支撑喉镜辅助下, 采用低温等离子消融刀头行单侧声带离断加同侧杓状软骨切除术治疗双侧声带外展麻痹的疗效。方法 对双侧声带外展麻痹的患者19例, 采用低温等离子消融术行单侧声带离断加同侧杓状软骨切除术进行治疗, 术后随访6～42个月, 分析评估该术式的临床效果。结果 19例术后呼吸功能恢复满意, 术后1个月内安全拔管18例, 其中术前已行气管切开8例。术后瘢痕挛缩喉腔狭窄未能拔管者1例, 经再次手术行对侧杓状软骨切除后成功拔管。嗓音评估发声效果满意14例, 轻微下降但患者能接受4例, 行2次手术者声嘶较前明显加重1例。结论 低温等离子单侧声带离断及同侧杓状软骨切除术治疗双侧声带外展麻痹, 术后呼吸困难完全缓解, 拔管率高, 发声功能保留良好。此术式创伤小, 术后愈合快, 安全、有效、微创。     

Cough intensity in patients with a vocal cord palsy

This study assesses the effect a paralysed cord has on the intensity of coughing. The air flow pattern during coughing of 10 patients with a vocal cord palsy was compared with a control group, using a computerized pneumotachograph system. There was no significant difference in the value of the peak air flow but the time taken to reach the maximum value was prolonged in the vocal cord palsy group. This non-invasive test may aid diagnosis of vocal cord palsies but the laterality of the lesion cannot be predicted from the airflow pattern alone.