Impaired vocal cord mobility in the setting of acute suppurative thyroiditis (original) (raw)
Related papers
Radiology and Diagnostic Imaging, 2017
Objective: To describe the mechanism and clinical course of vocal fold paralysis (VFP) following fine needle aspiration (FNA) of the thyroid gland. Case report: An 80-year old female presented to the emergency room due to hoarseness, dyspnea, and neck swelling. Her history was significant for FNA of the thyroid gland eight days earlier. Physical examination revealed left VFP and a left neck mass. Computed tomography of the neck was suggestive of a left neck hematoma. She was treated conservatively and her pain and neck swelling subsided gradually. Good left vocal movement was observed four months later. Conclusion: VFP is a rare complication of FNA of the thyroid gland. Physicians performing this procedure should be aware of this complication. We suggest that this sequela be discussed with the patient prior to the procedure and be included in the informed patient consent form.
An Atypical Cause of Hoarseness in a Patient With Thyroid Nodules
Military Medicine
Hoarseness due to vocal fold paresis (VFP) has a multitude of etiologies including systemic lupus erythematosus (SLE). During a clinical evaluation of a 58-year-old woman with long-standing hoarseness, an incidental finding of thyroid nodules was found to have VFP. Direct laryngoscopy and vocal fold biopsy confirmed the source was an inflammatory process involving the cricoarytenoid joint of the right hemilarynx. A presumptive diagnosis of SLE was made 3 years before meeting the clinical criteria of overt SLE. The VFP debut of SLE is extremely rare, and a literature review includes a handful of case reports (4 of a total of 37) since 1959. Only partial recovery of laryngeal function using glucocorticoids and Plaquenil was accomplished in the current case.
Laryngeal and vocal alterations after thyroidectomy
Brazilian Journal of Otorhinolaryngology, 2017
Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21).
The Prevalence of Undiagnosed Thyroid Disease in Patients With Symptomatic Vocal Fold Paresis
Journal of Voice, 2011
Objective. Vocal fold paresis has a multifactorial etiology and is idiopathic in many individuals. The incidence of thyroid-related neuropathy in the larynx has not been previously described. The purpose of this study was to evaluate the prevalence of previously undiagnosed thyroid disease in patients with laryngeal neuropathy and to compare this prevalence with that in a cohort of patients with a neurotologic neuropathy. Study Design and Setting. Case series with chart review; tertiary care, otolaryngology practice. Subjects and Methods. Charts of 308 consecutive patients with dysphonia and vocal fold paresis and 333 consecutive patients with sensorineural hearing loss, who presented for evaluation during a 3-year period, were reviewed. Results. One hundred forty-six of 308 (47.4%) patients with vocal fold paresis were diagnosed with concurrent thyroid disease, whereas 55 of 333 (16.5%) patients with sensorineural hearing loss were diagnosed with concurrent thyroid disease (P < 0.001, Pearson chi-square ¼ 92.896; degrees of freedom ¼ 5). Thyroid diagnoses among those with vocal fold paresis included benign growths (29.9%), thyroiditis (7.8%), hyperthyroidism (4.5%), hypothyroidism (3.6%), and thyroid malignancy (1.6%). Conclusions. Thyroid abnormalities are more prevalent in patients with dysphonia and vocal fold paresis than in patients with symptomatic sensorineural hearing loss, suggesting a greater association between previously undiagnosed thyroid abnormalities and laryngeal neuropathy than that between neurotologic neuropathy and thyroid disease.
A Rare Cause of Vocal Cord Palsy due to Small Thyroid Nodule
The Internet Journal of Head and Neck Surgery
Thyroid lesion is strongly associated with recurrent laryngeal nerve palsy. It is because of the close anatomical relationship between the gland on the trachea and the nerve which lies in the tracheoesophageal groove. The recurrent laryngeal nerve can be affected either from the thyroid disease itself or as the complication of thyroidectomy. However, benign thyroid lesion rarely causes recurrent laryngeal nerve palsy. We report a case of a small thyroid nodule causing unilateral vocal cord palsy. After lobectomy, the voice improved but due to the compensation mechanism of the opposite side. As the nerve was found to be atrophic intraoperatively, recovery should be allowed if it is going to take place, in a long period of time.
World Journal of Surgery, 2013
Background: Routine preoperative laryngeal examination remains controversial. We aimed to assess the utility of preoperative routine flexible laryngoscopy (FL) by looking at the incidence, clinical significance and predictors for preoperative vocal cord paresis (VCP) and incidental laryngopharyngeal condition (LPC) in our consecutive cohort. Methods: Three hundred and two patients underwent laryngeal examination by an independent otorhinolaryngologist and were specifically asked about voice/swallowing symptoms suggestive of VCP one day before surgery. Apart from vocal cord (VC) mobility, the naso-pharynx and larynx were examined using FL. Any VCP and/or LPC was recorded. VCP was defined as reduced or absent movement in ≥1 VC. A LPC was considered clinically significant if the ensuing thyroidectomy was changed or deferred. Results: Seven (2.3%) patients had preoperative VCP while an additional 7 patients had incidental LPC. Of the 7 VCPs, 5 were caused by previous thyroidectomy while 2 were by a benign goiter. The incidence of asymptomatic VCP in a previously non-operated cohort was 1/245 (0.41%). Voice/swallowing symptoms (p=0.033) and previous thyroidectomy (p<0.001) were the two significant predictors for VCP. The 7 incidental LPC were vallecular cyst (n=1), VC scar and polyp (n=2), nasopharyngeal cyst and polyp (n=3) and redundant arytenoid mucosa (n=1) but since they were benign, all 7 patients proceeded to thyroidectomy as planned. Conclusions: Given the low incidence (0.41%) of asymptomatic VCP in a previously non-operated cohort and none of the 7 LPCs were considered clinically significant, routine preoperative laryngoscopic examination should be reserved for those with previous thyroidectomy and/or voice/swallowing symptoms.
Polish Journal of Radiology
Transcutaneous laryngeal ultrasonography (TLUS) has become a cheap, convenient, and novel method in vocal fold (VF) assessment. The gold standard method of VF examination is laryngoscopy. It requires ear, nose, and throat specialist consultation and additional equipment. Moreover, laryngoscopy causes distress to patients, and during the COVID-19 pandemic it is a high-risk, aerosol-producing procedure. The aim of the paper was to review publications on the role of TLUS in VF evaluation. Considered aspects included VF visibility, factors affecting them, and different variables measured during TLUS examination. The visibility of VFs in TLUS ranged from 72.8 to 100%. Among men it was significantly lower (17-100%) in comparison to women (83-100%). All but 2 authors concluded that TLUS is a viable tool that can be an alternative to laryngoscopy in diagnosing VFs. Obesity, age, male gender, height, calcified thyroid, and incision close to the thyroid cartilage were independent factors for inaccessible vocal folds. VF displacement velocity (VFDV) is the most objective parameter measured by Doppler, and it is proportional to the velocity of the wave causing the vibrations of the VFs. After VF paralysis, this parameter is reduced. Valsalva manoeuvre, low-frequency transducer, and different transducer positions can improve images obtained on USG. TLUS in a majority of cases can adequately assess whether the function of the VFs is intact or paresis/paralysis has occurred. It is noninvasive and rapid, it adds no extra cost, and it can be a part of the preoperative examination of the thyroid gland. TLUS can usually be a convenient alternative to laryngoscopy.