A Patient With Unilateral Vocal Cord Paralysis Presenting to the Emergency Department With Voice Changes and Dyspnea

TL;DR

A 72-year-old woman with a raspy voice and breathing difficulties was found to have vocal cord paralysis likely caused by recent surgery and intubation.

Contribution

Highlights the importance of nasopharyngolaryngoscopy in emergency evaluations for voice and breathing issues.

Findings

Nasopharyngolaryngoscopy revealed left-sided unilateral vocal cord paralysis.

The patient's condition was likely caused by recent endotracheal intubation.

Multidisciplinary evaluation confirmed the diagnosis and ruled out other serious causes.

Abstract

Unilateral vocal cord paralysis can cause a change in phonation and dyspnea and can be a cause of distress for a patient. The causes are varied and include post-surgical and post-intubation causes, malignancy, and other etiologies. Here, we present the case of a 72-year-old female who presented to the ED with a new onset of a "raspy voice" and dyspnea and had undergone an L4-L5 laminectomy with associated endotracheal intubation two weeks prior to ED presentation. Because of the complaint of a change in her voice, a nasopharyngolaryngoscopy (NPL) was performed, which demonstrated left-sided unilateral vocal cord paralysis. The patient was admitted to the hospital and was evaluated by neurology, pulmonology, and otolaryngology services. The discharge diagnosis was unilateral vocal cord paralysis, most likely caused by the patient's recent intubation. This case demonstrates the value of an NPL in the ED as part of the evaluation of a patient with dyspnea and a change in phonation.

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