Vol 5 | Issue 1 | Jan-April 2019 | page: 9-10 | Meghena Mathew, Nagarajan Ramakrishnan, Ashwin K Mani
Authors: Meghena Mathew , Nagarajan Ramakrishnan , Ashwin K Mani .
 Department of critical care medicine
Address of Correspondence
Dr. Ashwin K Mani,
Department of critical care medicine,
Apollo First Med Hospital, Chennai.
Introduction: We present a rare cause of chronic hypercapnic respiratory failure due to bilateral vocal cord palsy. Identification of chronic bilateral vocal cord palsy as a cause for respiratory failure in an intensive care unit (ICU) can be challenging and the treatment may warrant not only mechanical ventilation but tracheostomy.
Case presentation: A 70-year-old lady presented to us with worsening dyspnea of 10 days duration and stridor of 34 years duration. She had a history of childhood diphtheria. She failed non-invasive ventilation (NIV) for type-2 respiratory failure and required early tracheostomy. Her respiratory failure and clinical condition remarkably improved post tracheostomy. Flexible laryngoscopy showed bilateral vocal cord palsy.
Conclusion: Differentiating the upper airway pathology from obstructive diseases of the lower airway as cause for chronic respiratory failure is essential in a critical care unit, as NIV may not be of any benefit in the former. This case report highlights the importance of considering upper airway disease causing chronic respiratory failure which would require a different clinical management including early intubation with tracheostomy.
Keywords: respiratory failure, vocal cord palsy
1. Reichler BD1, Scelsa SN, Simpson DM. Hereditary neuropathy and vocal cord paralysis in a man with childhood diphtheria. Muscle Nerve. 2000 Jan;23(1):132-7.
2. Pinto JA, Godoy LB, Marquis VW, Sonego TB. Leal Cde F. Bilateral vocal fold immobility: diagnosis and treatment. Braz J Otorhinolaryngol2011; 77:594–9.
3. Harnisch W, Brosch S, Schmidt M, Hagen R. Breathing and voice quality after surgical treatment for bilateral vocal cord paralysis. Arch Otolaryngol Head Neck Surg2008; 134:278–84.
4. Parnell FW, Brandenburg JH. Vocal cord paralysis. A review of 100 cases. Laryngoscope. 1970;80(7):1036-45.
5. KearsleyJVH.ocal cord paralysis (VCP): an aetiologic review of 100 cases over 20 years. Aust NJM1Zed. 981; 11:663-666.
6. Barondess JA, Pompei P, Schley WS. A study of vocal cord paralysis. Trans Am Clin Clim Assoc. 1985; 97:141- 148
7. Chetty KG, McDonald RL, Berry RB, Mahutte CK. Chronic respiratory failure due to bilateral vocal cord paralysis managed with nocturnal nasal positive pressure ventilation. Chest 1993;103: 1270–1.
8. Amis RJ, Gupta D, Dowdall JR, Srirajakalindini A, Folbe A. Ultrasound assessment of vocal fold paresis: a correlation case series with flexible fiberoptic laryngoscopy and adding the third dimension (3-D) to vocal fold mobility assessment. Middle East J Anesthesiol2012; 21:493–8.
9. Sterner JB, Morris MJ, Sill JM, Hayes JA. Inspiratory flow-volume curve evaluation for detecting upper airway disease. Respir Care 2009; 54:461–6.
|How to Cite this Article: Mathew M, Ramakrishnan N, Mani A K. Chronic respiratory failure from bilateral vocal cord palsy. Journal of Anaesthesia and Critical Care Case Reports Jan-April 2019;5(1):9-10.|