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5.Unilateral vocal cord paralysis following a short period of endotracheal intubation anesthesia.

Yeun Hee SHIN ; Dong Ai AN ; Won Joon CHOI ; Yun Hong KIM

Korean Journal of Anesthesiology 2013;65(4):357-358

Introduction: Ortner’s syndrome encompasses any intrathoracic process resulting to stretching of the recurrent laryngeal nerve. The stress to this nerve weakens the intrinsic muscles of the larynx and manifests as vocal hoarseness. Case: A 46-year-old female was admitted due to progressive hoarseness. She tolerated this for six months until the onset of other symptoms like orthopnea, bipedal edema, and chest pain. She consulted various doctors and was initially diagnosed with chronic laryngitis from gastroesophageal reflux disease. She was given omeprazole and spironolactone that afforded little help. On examination, the precordium was dynamic with heaves and thrills, PMI was displaced, and systolic murmurs were heard. The ECG revealed left ventricular hypertrophy with left atrial abnormalities. Chest radiograph showed leftsided cardiomegaly. A 2D-echocardiogram divulged severe mitral regurgitation, anterior mitral valve leaflet thickening, and dilated left atrium. Therefore, the impression was Ortner’s syndrome, rheumatic heart disease. The patient underwent mitral valve replacement. She was given warfarin, bisoprolol, losartan, spironolactone, and vitamin B complex. At subsequent visits, she reported improvement in her voice. Penicillin injections were also given as secondary prophylaxis. A repeat 2D-echocardiogram displayed a decrease in size of the left atrium. Conclusion This case has emphasized three important points: First, a comprehensive history and physical examination is vital to reach the correct diagnosis. Second, once the common causes of hoarseness have been excluded yet symptoms persist, it is therefore prudent to look beyond the larynx. And third, the vocal cord paralysis experienced by the patient is just the tip of the iceberg. Her heart is the one dying to be heard.
Vocal Cord Paralysis ; Hoarseness ; Heart Failure