# Bilateral Vocal Cord Paralysis Following Influenza A: Case Report

## TL;DR

A rare case of bilateral vocal cord paralysis following influenza A infection is reported, highlighting the need for clinicians to consider this complication.

## Contribution

This case report adds influenza A to the list of viral causes of bilateral vocal cord paralysis.

## Key findings

- Bilateral vocal cord paralysis occurred following influenza A infection in a 57-year-old male.
- Exclusion of other causes and spontaneous recovery support a post-viral inflammatory mechanism.
- The patient required ICU care and corticosteroid therapy but recovered fully within two months.

## Abstract

Bilateral vocal cord paralysis (BVCP) is a rare but potentially life‐threatening condition. Viral infections such as COVID‐19, herpes simplex virus, Epstein–Barr virus, and cytomegalovirus have been widely reported; however, influenza A is a rarely reported cause. We describe a 57‐year‐old male who developed BVCP following an influenza A infection. Comprehensive investigations, including neuroimaging and nerve conduction studies, ruled out structural, neoplastic, demyelinating, medication‐related, and autoimmune causes. A transient CMV viremia was identified but deemed a secondary phenomenon due to immunosuppression. The patient required intubation, intravenous corticosteroid therapy, and ICU care. Vocal cord function gradually improved over several weeks, with complete resolution at 2 months. The temporal relationship, exclusion of other etiologies, and spontaneous recovery are very consistent with a post‐viral inflammatory mechanism secondary to influenza A. Clinicians should maintain clinical suspicion for bilateral vocal cord paralysis following influenza A for future practice.

Our consensus identified influenza A as the most likely cause of this patient's BVCP despite confounding factors such as multiple myeloma, CMV viremia, and pomalidomide exposure. Clinicians should remain vigilant, as influenza‐related BVCP may occur even with comorbidities and provided other potential etiologies are appropriately excluded.

Flexible nasal endoscopy demonstrating bilateral vocal cord paralysis (BVCP) in the paramedian position. The left image demonstrates a glottic gap between the vocal cords (white arrows) in the maximally adducted position (patient saying “eeee”). Under normal circumstances the vocal cords should be touching with no glottic gap. The right image shows his vocal cords (white arrows) during inspiration (the maximally abducted position), which has only minimally moved in comparison to the left image. The vocal cords should be 9 mm away from the midline on full abduction.