Vol.97 No.9 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 97 No.9 September 2004
Examination of Thoracic Aortic Aneurysm-related
Laryngeal Paralysis
Keiju Tsubaki, Kousuke Ishii, Hideo Adachi,
Yasushi Oota and Takeshi Shinozaki
(Omiya Medical Center, Jichi Medical School)
Masanori Yamamoto
(Jichi Medical School)
Subjects and Methods: The subjects were 9 patients who consulted our hospital for thoracic aortic aneurysm-related laryngeal paralysis, which was not associated with surgery, between April 1999 and March 2002. We investigated the findings on the initial consultation, aneurismal features, and prognosis of laryngeal paralysis in each patient.
Results: On the initial consultation, hoarseness was observed in all subjects, and aspiration was noted in 4 patients. There was no vocal motility in 8 patients (the accessory midline and intermediate position were fixed in 7 and 1 patients, respectively), whereas slight vocal motility was observed in 1 patient. No patient showed vocal atrophy. Concerning the aneurysmal features, the aneurysm diameter ranged from 55 to 75 mm, and all lesions were present around the arch. In 5 patients, the course could be followed. Four of these patients subsequently underwent thoracic surgery. In Patients 3 and 9, there was no vocal motility after surgery, and atrophy occurred with the deterioration of the hoarseness and aspiration. In Patients 1 and 5, vocal motility appeared, and improvement in the hoarseness and aspiration was achieved. Patient 6 did not undergo thoracic surgery, and the symptoms deteriorated.
Conclusion: The size of the aneurysms that caused laryngeal paralysis was similar to that in other patients for whom thoracic surgery was indicated; laryngeal paralysis is an indication for thoracic surgery. In some patients, the symptoms deteriorated after thoracic surgery, whereas improvement in paralysis relieved the symptoms in other patients. Furthermore, improvement in laryngeal paralysis after surgery or improvement in the symptoms in the presence of persistent paralysis was achieved in some patients; therefore, patients should be instructed to start rehabilitation before surgery.
Key words : thoracic aortic aneurysm, laryngeal paralysis, aspiration pneumonia