The authors present an unusual case of right vocal fold paralysis. Their patient was a 38-year-old woman who experienced new onset dysphonia following neuraxial anaesthesia (NA) for a caesarean section. Flexible nasendoscopy showed a right VFP with fixation in the paramedian position and vocal fold bowing. Treatment included oral steroids, reflux management and voice therapy. Her voice quality returned to normal within 10 months, however her VFP had not improved by 18 months. Contrast CT scan showed no abnormalities, but the patient refused laryngeal electromyography. The authors hypothesised that the VFP was caused by neural complications following NA and present a scoping review of the evidence for this. They identified eight studies for inclusion in the review, comprising a total of 12 patients (11 women, one man) with 13 episodes of VFP following NA. VFP was unilateral in 12 episodes (9/12 right sided), and bilateral in one. Only 5/13 cases fully recovered vocal fold mobility. Treatment options ranged from steroids, voice therapy and, in one case, injection medialisation. Three of the studies provided results of electromyography which showed involvement of the superior and recurrent laryngeal nerve, suggesting vagal nerve injury. However, the studies were all either case series or case reports, therefore represented a low level of evidence, with minimal data to identify true causality between NA and VFP but enough grounding to show the need for further research into the etiopathogenetic mechanisms and increase clinician awareness for future diagnosis and management.
How rare is vocal fold paralysis after spinal and epidural anaesthesia – should we be more concerned?
Reviewed by Gemma Clunie
Vocal Fold Paralysis After Spinal and Epidural Anesthesia: A Case Report and Scoping Review.
CONTRIBUTOR
Gemma Clunie
BA (Hon), MSc, PhD, MRCSLT, Imperial College Healthcare NHS Trust; Honorary Research Fellow, Imperial College London, UK.
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