Eight Cases of Viral Associated Laryngeal Paralysis

Abstract

To reveal the characteristics of viral associated laryngeal palsy, we performed a clinical study through a chart review of patients visiting our department between June 2003 and December 2007. A total of 8 cases (7 men, 1 woman;age range, 21-86) with viral associated laryngeal paralysis were assessed for causes, severity, prognosis and treatments. The most frequent chief complaints were dysphagia (6 cases), hoarseness (5 cases), otalgia (3 cases), hearing loss (3 cases) and facial rash (2 cases). In all cases, VZV reactivation was considered to be the causative agent through serological study. Vocal cord paralysis was complete in 7 cases and incomplete in 1 case. The affected side was right in 4 cases, left in 3 cases and bilateral in 1 case. Aside from vocal cord palsy, the vagus nerve (8 cases), glossopharyngeal nerve (8 cases) and cochleovestibular nerve (2 cases) were frequently involved. Treatment included acyclovir (6 cases), steroid (6 cases), rehabilitation (5 cases) and operation (2 cases). Vocal cord palsy improved in 7 cases within 5.3 months on average (fully recovered in 2 cases;partially recovered in 5 cases). The affected cranial nerves revealed improvement in all cases within 3.6 months (fully recovered in 6 cases;partially recovered in 2 cases). Swallowing function was evaluated in 7 cases by videofluoroscopy : 1 case was within the normal limits;1 case revealed oral swallowing dysfunction;5 cases revealed oral and pharyngeal swallowing dysfunction;and aspiration was observed in 4 out of 7 cases. Swallowing dysfunction revealed various degrees of improvement during follow-up, and aspiration disappeared in all cases followed. Although viral involvement is a good prognostic indicator in associated laryngeal palsy, functional improvement usually takes several months. A high level of attention is needed at the time of diagnosis, and early administration of acyclovir and steroid is considered favorable.