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.

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

Any process involving either the vagus nerve, its recurrent laryngeal branch or the external branch of the superior laryngeal nerve may cause paralysis of the vocal fold. The most common cause is neoplasm. Clinically, the patients often present with a hoarse, breathy voice as well as symptoms of aspiration. The following represents a unique case of unilateral vocal fold paralysis and dysphagia caused by a degenerative disease of the cervical spine, resluting in extrinsic compression of the recurrent laryngeal nerve.

True vocal fold paralysis and goitre are both common problems encountered in ENT practice. Their co-existence, however, should arouse suspicion of the presence of malignant thyroid disease. A rare case of true vocal fold paralysis caused by a clinically occult subglottic adenoid cystic carcinoma, in a 72-year-old, is described. The existence of multinodular goitre in this patient was co-incidental and confounded the diagnostic process.

According to the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology – Head and Neck Surgery, various surgical methods such as laryngeal framework surgery, laryngeal re-innervation, and injection laryngoplasty might be used to palliate inferior laryngeal nerve paralysis. In the present case report we document the survival and exact location of the boluses of autoiogous fat in one patient in whom this material was used for injection laryngoplasty.

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder that can affect the upper airway. Hydralazine has been known to cause a lupus-like syndrome that can produce the clinical manifestations of SLE. We discuss a case of hydralazine-induced lupus, presenting with acute laryngeal oedema and right vocal fold paralysis. Cessation of hydralazine therapy resulted in reversal of paralysis.

A patient is presented who had bilateral abductor vocal fold paralysis pathologically proven to be due to multiple system atrophy (MSA) in the absence of other neurological features. MSA is a degenerative neurological condition that includes olivopontocerebellar atrophy, Shy-Drager syndrome and striatonigral degeneration. The usual predominant features of MSA are cerebellar ataxia, autonomic dysfunction and Parkinsonism. Stridor is present in over one third of patients and has been reported previously as a presenting symptom in MSA: however previously reported patients have always gone on to develop other neurological symptoms. The usual investigations of bilateral abductor vocal fold paralysis caused by MSA will not reveal the pathological process and we believe that magnetic resonance imaging (MRI) of the medulla and brain stem and autonomic function tests are probably the investigations of choice. It is a worthwhile exercise attempting to identify MSA as the cause of stridor as the prognosis is good in the medium term if appropriate support is offered.

The purpose of this retrospective study was to describe and evaluate the results of arytenoidopexy performed by the external laterocervical approach in 15 consecutive children presenting bilateral vocal fold paralysis causing life-threatening airway compromise. Mean age at the time of surgery was 20 months and mean follow-up was 42 months. At the end of follow-up all patients were in good health and did not need special care for breathing. No abduction movement has been observed on the opposite vocal fold since arytenoidopexy. One failure subsequently required arytenoidectomy. The findings of this study suggest that arytenoidopexy is an effective surgical treatment for life-threatening bilateral vocal fold paralysis in young children.

Malignancy is a major cause of vocal fold paralysis. Nevertheless, metastatic disease at the brainstem leading to high vagal paralysis is rarely encountered. We illustrate an unusual case of unilateral vocal fold paralysis caused by dural metastasis directly compressing on the nucleus ambiguus. The median position of the paralysed vocal fold is inconsistent with the Wagner and Grossman theory predicting the location of the lesion.

The case of an elderly male with Shy-Drager syndrome is presented. His presentation to the Sleep Clinic for assessment of snoring illustrates bilateral abductor vocal fold palsy as a rare presentation of the syndrome. This case emphasizes the need for thorough investigation of all patients with sleep-related breathing disorders with video and sound recordings prior to anaesthesia and surgery.

This review article discusses the surgical treatment of patients suffering from unilateral vocal fold paralysis who have already been assessed and considered appropriate candidates for surgery. There are currently three main methods of surgical rehabilitation; injection medialisation; laryngeal framework surgery; re-innervation procedures.

Since its introduction in the 1960's the injection of Teflon into a paralysed vocal fold has become a standard treatment in laryngology. Although in recent years alternative treatments have been suggested, such as the injection of collagen or autogenous fat (Mikaelian et al., 1991), re-innervation procedures and thyroplasty (Crumley, 1990), the use of Teflon is still widespread (Rontal and Rontal, 1991; Dedo, 1992). Various instruments have been developed for the application of Teflon paste and these take the form of a gun-like syringe with a ratchet mechanism. For a number of years we have injected Teflon using a needle marketed for internal jugular vein cannulation along with a plastic 1 ml syringe thus making substantial savings to our department in terms of both time and cost.

Invasive peri- and post-operative monitoring is being increasingly utilized, and a corresponding increase of concomitant complications are becoming apparent.

Two cases of complete right vocal fold paralysis are reported as a possible complication of right central venous catheterization. The underlying aetiology of this complication is presumed to be either direct trauma at the time of introduction of the central venous catheter, or by thrombosis and fibrosis around the recurrent laryngeal or vagus nerve. It is suggested that multiple attempts at cannulation and leaving the central line in situ for long periods increases the risk of this complication.

When the integrity of the left recurrent laryngeal nerve or vagus is jeopardized or must be sacrificed during surgery, it is suggested that ipsilateral central lines are inserted to minimize the risk of bilateral vocal fold paralysis.

Cases of vocal fold paralysis secondary to central line insertion should be followed expectantly and surgical intervention only be considered after 12 months review.

A pseudotumour represents a lesion that masquerades as a malignant neoplasm. We present an unusual case where the appearance of a tumour was the result of chronic inflammation stimulated by the presence of food matter. This inflammatory reaction resulted in upper airway obstruction associated with a mass lesion and vocal fold palsy.

Teflon injection has been widely used for the treatment of unilateral vocal fold paralysis. Complications are few and infrequent. Overinjection and Teflon granuloma are the two commonest problems encountered. Treating such complications and restoring vocal quality is widely regarded as difficult. Endoscopic transmucosal excision of the excess Teflon and/or granuloma has not been successful in improving phonatory quality. Cordectomy is proposed as an alternative surgical approach for managing both the convex vocal fold and Teflon granuloma after injection.

A case of bilateral laryngeal nerve paralysis caused by a small goitre is reported. After thyroidectomy the return of vocal fold movements was observed. A review of the literature is presented. The possibility of acute airway distress caused by a slightly enlarged goitre is emphasized.

With easier access to more sophisticated imaging techniques, the investigation of vocal fold palsy is reassessed. A questionnaire was sent to all ENT surgeons in the UK to establish which imaging techniques are available to ENT departments and which tests are currently requested during the investigation of vocal fold palsy.

An extensive literature review established the aetiology of vocal fold palsy and the sensitivity and specificity of radiological investigations.

A simple protocol is proposed which would be suitable to implement in the majority of ENT departments in the UK.