Vocal cord paralysis in children

Bilateral vocal cord paralysis is a common cause of stridor in infants and children. There are significant differences in this entity between children and adults with regard to etiology, diagnosis, management, and outcome. A review of 10 years' experience at Children's Hospital of Philadelphia identified 51 children seen with the diagnosis of vocal cord paralysis. These cases were evaluated with respect to etiology of paralysis, whether unilateral or bilateral, delay in diagnosis, need for tracheotomy, abnormality of voice, surgical treatment, and outcome. Guidelines for management for a child with vocal cord paralysis are presented with emphasis on flexible endoscopic evaluation and conservative management.     

Vocal cord paralysis with Ebstein's anomaly

Left recurrent laryngeal nerve runs a long intrathoracic course in close relationship to the aortic arch and adjacent heart structures and, hence, is liable to be injured by diseases affecting the heart and its great vessels. We report a case of Ebstein's anomaly causing left recurrent laryngeal nerve paralysis in a neonate. To our knowledge, this is the first reported case of vocal cord paralysis associated with this condition.     

Vocal cord paralysis caused by stingray

Foreign bodies in the oral cavity and pharynx are commonly encountered in the emergency room and outpatient departments, and the most frequently observed of these foreign bodies are fish bones. Among the possible complications resulting from a pharyngeal foreign body, vocal cord fixation is extremely rare, with only three cases previously reported in the English literature. The mechanisms of vocal cord fixation can be classified into mechanical articular fixation, direct injury of the recurrent laryngeal nerve, or recurrent laryngeal nerve paralysis secondary to inflammation. The case discussed here is different from previous cases. We report a rare case of vocal cord paralysis caused by the venom of a stingray tail in the hypopharynx.     

Vocal cord paralysis in postpoliomyelitis syndrome

Postpoliomyelitis syndrome is characterized by new neuromuscular symptoms, including weakness, developing years after recovery from acute polio. Bilateral vocal cord paralysis is presented as a new manifestation of this syndrome. Other clinical features of post-poliomyelitis syndrome in this report are discussed. The etiology of this syndrome is unknown, though attrition or immune-mediated destruction of collateral muscular innervation appears likely. The pathologic findings include scattered individual muscle fiber atrophy as well as evidence of chronic denervation and reinnervation. This form of motor deterioration is not life-threatening, but potentially may cause increasing disability in a large number of polio survivors. Proper supportive care of facial, laryngeal, and pharyngeal weakness is crucial in the management of these patients.     

Vocal cord paralysis following child abuse

Otorhinologic manifestations of child abuse are infrequently reported in the literature. Three cases of vocal cord paralysis following child abuse are presented. The pathophysiology of vocal cord paralysis is reviewed as it relates to pediatric vocal cord paralysis. Recognition of the possibility of vocal cord paralysis in an abused child who suffers significant head trauma or a strangulation injury is necessary to insure a more rapid diagnosis and initiation of effective therapy more promptly.     

Vocal cord paralysis in infants and children

Vocal cord paralysis is the second most common cause of neonatal stridor. Recognition of laryngeal paralysis warrants further evaluation for an underlying etiology as it is frequently a manifestation of a multisystem anomaly. Initial intervention must concentrate on airway stabilization and treatment of any underlying conditions. Management strategies should be individualized and focus on maintenance of a safe and stable airway, acquisition of intelligible speech, and deglutition without aspiration.     

Vocal cord paralysis associated with cystic fibrosis

The course of the left recurrent laryngeal nerve through the chest brings it in close proximity with the heart and great cardiac vessels. Diseases of the heart and the great vessels are known to cause vocal cord paralysis, probably by mechanical injury to the recurrent laryngeal nerve. Pulmonary artery hypertension and dilation occur in up to 80% of patients with cystic fibrosis. We report a case of a 23-year-old woman with cystic fibrosis and left vocal cord paralysis. We believe that sudden pulmonary artery expansion produced recurrent laryngeal nerve injury and vocal cord paralysis. This is only the second association of unilateral vocal cord paralysis and cystic fibrosis in the medical literature. The pathophysiology of the cardiovocal syndrome is discussed.     

Vocal cord paralysis after laryngeal mask airway ventilation

The laryngeal mask airway (LMA) is being used with increasing frequency since its introduction into the United States in 1991. Currently, the LMA is being used in the United States in approximately one third of all operations or greater than 100 million surgeries. In Britain, where it was first introduced for use in 1988, the LMA is estimated to be used in up to 50% of cases. Not only has its use in elective cases increased, but the scope of indications for the LMA has also grown. Its use in emergent and difficult airway management has increased, and new LMA products have been introduced to address the limitations of the classic model. As the LMA has increased in popularity, however, so has the incidence of LMA-related complications. Cases of mucosal trauma, hematoma, tongue cyanosis, arytenoid dislocation, and lingual, hypoglossal, and recurrent laryngeal nerve paralyses have been documented in various anesthesia journals. Reports of these injuries are sparse in the otolaryngology literature. As otolaryngologists who will manage the sequelae of LMA-related injuries, we must remain cognizant of potential problems and their underlying mechanisms. We report a case of unilateral vocal cord paralysis, which required operative repair after the use of an LMA. We review the existing case reports, propose mechanisms of injury, and discuss practical applications of our findings.     

Vocal cord paralysis and recovery with thyroid lymphoma

Vocal cord paralysis has been reported in 33 patients with thyroid lymphoma for an estimated overall incidence of 17%. There is little expectation of vocal cord function recovery, both because neoplastic invasion is believed irreversible and since surgery often necessitates sacrifice of the recurrent laryngeal nerve. Unlike in most well differentiated thyroid malignancies, external radiation therapy plays a vital role in the treatment of thyroid lymphoma. The patient presented here had complete recovery of vocal cord function following radiation therapy for a large thyroid lymphoma associated with vocal cord paralysis. This is the first reported case of such recovery following treatment for a thyroid neoplasm. The rather rapid and complete recovery of neural function suggests that, at least in some, paralysis is caused by reversible compression rather than by neural invasion or tumor-induced neurolysis.     

人胶原声带注射治疗周围性单侧声带麻痹

目的：观察人胶原声带注射治疗周围性单侧声带麻痹的效果。方法：在强化局麻或全麻支撑喉镜下，对6例单侧声带麻痹病人行人胶原患侧声带注射。评估注射前后声带位置、声嘶改善状况及声学参数变化。结果：6例中5例术后声嘶明显改善，患侧声带移向正中位，声门关闭良好；1例声嘶改善不明显，患侧声带位置无变化。6例皆未出现不良反应。频率微扰(Jitter)、振幅微扰(Shimmer)及标准噪声能量(NNE)值术后明显下降，最大声时(MPT)延长，经统计学处理均有统计学意义；谐噪比(H/N)得到改善。结论：人胶原声带注射治疗单侧声带麻痹是一种方法简单、疗效确切、安全、病人痛苦小、价格低廉、易于临床推广的方法。     

Vocal cord paralysis following approaches to the anterior cervical spine

The charts of 85 patients who had undergone an approach to the anterior cervical spine between 1966 to 1970 were reviewed. Nine of them (11 percent) showed postoperative voice changes, three of those had permanent vocal cord paralysis. The possible causes of recurrent nerve damage are discussed.