6 - ENT - Upper airway - Voice - Causes of voice change - Neuromuscular - RLN Palsy/paresis

Question 1

RLN palsy/paresis - causes

Answer 1

1/3rd traumatic - surgical, neck trauma
1/3rd neoplastic - bronchial, thyroid, oesophagus, intracranial
1/3rd other - idiopathic (prob viral), neurological (MND, MS, PD), thoracic lesions

Question 2

RLN palsy/paresis - Sx

Answer 2

weak voice, tries with use

perilaryngeal discomfort, choking with fluids, higher pitched voice, diplophonia, weak cough

Question 3

RLN palsy/paresis - Si

Answer 3

immobile vocal cord

-Left side 75%, right side 15%, bilat 10% airway risk!!

Question 4

RLN palsy/paresis - Ix

Answer 4

CXR - exclude mediastinal mass
CT skull base to midthorax (look for lesions along nerve)
Barium swallow - for oesophageal lesion or aspiration

Question 5

RLN palsy initial mgmt

Answer 5

none - await spontaneous recovery

voice therapy

Question 6

RLN palsy - mgmt if bilateral?

Answer 6

tracheostomy maybe initially to maintain airway

Question 7

RLN palsy surgical mgmt

Answer 7

medialisation (bring chords together)

• inject synthetic polymer, collagen, fat, fascia
• insertion of spacer implant lateral to folds