Rare Causes of Unilateral Vocal Fold Paralysis: Report of 3 Cases with Review of Literature
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CLINICAL REPORT
Rare Causes of Unilateral Vocal Fold Paralysis: Report of 3 Cases with Review of Literature Shruti Dhingra1
•
Ruchika Juneja1
•
Farha N. Kazi2,3,4 • Nupur Nerurkar5
Received: 27 July 2020 / Accepted: 25 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Unilateral vocal fold paralysis is a common finding with a variety of underlying causes. The six main etiologic groups include neoplastic, traumatic (iatrogenic, accidental) neurological, inflammatory, congenital, and idiopathic. Various unusual causes have been described including foreign body ingestion, mediastinal lymph nodes, large pleural blebs, tracheal diverticulum, etc. It is therefore essential, that a thorough evaluation and methodical approach be undertaken to ascertain the etiology, before labelling it as idiopathic and offering any treatment. This review article focuses on the uncommon and rare causes of unilateral vocal fold paralysis that are presented through 3 representative case reports; a cardio-vocal (Ortner’s) syndrome, Zenker’s diverticulum and diffuse idiopathic skeletal hyperostosis. These examples are discussed with radiological findings in the context of current literature.
& Shruti Dhingra [email protected]
Keywords Vocal fold paralysis Zenker’s diverticulum Diffuse idiopathic skeletal hyperostosis Ortner’s syndrome Hoarseness
Introduction Unilateral vocal fold paralysis is a common presentation to any voice clinic. The etiology may be attributed to multiple causes both within and outside the larynx. These may range from congenital, inflammatory, infective, endocrine, benign, and malignant laryngeal lesions to neurogenic, psychogenic, or iatrogenic causes. When no organic lesion is found in the neck, focus shifts to the skull base and mediastinum. Besides the common causes, the otolaryngologist needs to be aware of the rare clinical entities that may masquerade a life-threatening complication, if ignored. We report 3 cases that presented to the Otolaryngology clinic for evaluation of hoarseness as the primary complaint and discuss each one of them.
Ruchika Juneja [email protected]
Case 1
Farha N. Kazi [email protected]
A 40-year old male presented with chief complaints of hoarseness for 4 months and a mild fever over the past 1 week. There was no associated dyspnea, dysphagia, or cough. The patient was a smoker and a diabetic for the last 4 years, controlled on oral hypoglycemic agents. The left vocal fold was seen to be immobile and in the paramedian position. The rest of the oral cavity and laryngopharynx was within normal limits. A contrast-enhanced computed tomography scan of skull base to the diaphragm revealed a contrast filled bilobed out-pouching from the inferior aspect of the arch of aorta, just at the origin of the left
Nupur Nerurkar [email protected] 1
Department of Otolaryngology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, India
2
Voice and Swallowing Clinics, Navi Mumbai, India
3
MPCT Hospital, Navi Mumbai, India
4
Apollo Hosp
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