Summary about Disease
Recurrent laryngeal nerve palsy (RLNP) is a condition that occurs when the recurrent laryngeal nerve, which controls most of the muscles in the larynx (voice box), is damaged or paralyzed. This paralysis can affect voice quality, breathing, and swallowing. RLNP can be unilateral (affecting one side) or bilateral (affecting both sides), with bilateral paralysis posing a greater risk to breathing.
Symptoms
Common symptoms of RLNP include:
Hoarseness or a breathy voice
Vocal fatigue
Difficulty projecting the voice
Changes in voice pitch
Coughing or choking while eating or drinking
Shortness of breath, especially with exertion (more common in bilateral paralysis)
Stridor (a high-pitched, wheezing sound during breathing, indicating airway obstruction - more common in bilateral paralysis)
Causes
RLNP can be caused by:
Surgery: Thyroid surgery, parathyroid surgery, carotid artery surgery, neck dissection, and other surgeries near the nerve.
Tumors: Tumors in the neck, chest, or skull base that compress or invade the nerve.
Trauma: Injury to the neck or chest.
Infections: Viral infections that affect the nerve.
Neurological conditions: Certain neurological disorders can affect nerve function.
Idiopathic: In some cases, the cause is unknown (idiopathic RLNP).
Medicine Used
Medications are not typically the primary treatment for RLNP, but they may be used to manage related symptoms or underlying causes. Examples include:
Proton Pump Inhibitors (PPIs): For laryngopharyngeal reflux (LPR) that can exacerbate voice problems.
Corticosteroids: To reduce inflammation if an inflammatory cause is suspected (though evidence is limited).
Antibiotics/Antivirals: If an infection is identified as the cause.
Neuromodulators (Gabapentin or Amitriptyline): In cases when nerve pain or nerve hypersensitivity is experienced.
Is Communicable
Recurrent laryngeal nerve palsy itself is not communicable. It is not an infectious disease and cannot be spread from person to person. The underlying cause of the palsy, if infectious (e.g., a viral infection), might be communicable, but the nerve damage itself is not.
Precautions
Precautions depend on the severity of the palsy and its impact on breathing and swallowing. Some general precautions include:
Swallowing precautions: Following speech therapist recommendations regarding food and liquid consistencies to prevent aspiration.
Voice rest: Avoiding excessive talking or straining the voice.
Hydration: Staying well-hydrated to keep vocal cords lubricated.
Avoid irritants: Avoiding smoking, alcohol, and other irritants that can exacerbate voice problems.
Monitoring breathing: Being aware of any signs of airway obstruction (stridor, shortness of breath) and seeking immediate medical attention if they occur, especially in cases of bilateral RLNP.
How long does an outbreak last?
RLNP is not an "outbreak" disease like an infection. It's a condition resulting from nerve damage. The duration of symptoms depends on the cause, the severity of the palsy, and the effectiveness of treatment. Some cases may resolve spontaneously over weeks or months, while others may be permanent.
How is it diagnosed?
Diagnosis typically involves:
Medical history and physical exam: Reviewing the patient's symptoms, medical history, and performing a physical examination.
Laryngoscopy: A procedure where a doctor uses a flexible or rigid scope to visualize the larynx and vocal cords. This helps assess vocal cord movement.
Voice evaluation: Speech-language pathologist evaluates voice quality, pitch, loudness, and resonance.
Electromyography (EMG) of the larynx: Measures the electrical activity of the laryngeal muscles to assess nerve function.
Imaging studies: CT scans or MRI scans of the neck and chest to rule out tumors or other structural abnormalities that may be compressing the nerve.
Timeline of Symptoms
The onset of symptoms can vary depending on the cause.
Post-surgical: Symptoms may appear immediately after surgery or within a few days.
Tumor-related: Symptoms may develop gradually over weeks or months as the tumor grows.
Infection-related: Symptoms may appear suddenly after a viral illness.
Trauma-related: Symptoms may appear immediately after the injury.
Idiopathic: Onset may be gradual and unexplained. The timeline for recovery, if any, is highly variable and depends on the specific situation.
Important Considerations
Airway compromise: Bilateral RLNP can be life-threatening due to airway obstruction. Immediate medical intervention (tracheostomy) may be necessary.
Swallowing difficulties: Aspiration pneumonia is a risk for patients with RLNP who have difficulty swallowing.
Voice quality: The impact on voice quality can affect communication, work, and social interactions.
Multidisciplinary approach: Management of RLNP often involves a team of specialists, including otolaryngologists (ENT doctors), speech-language pathologists, neurologists, and pulmonologists.
Treatment options: Treatment options depend on the cause and severity of the palsy and may include voice therapy, surgery (e.g., vocal cord medialization), or observation.