2017 Volume 149 Pages 42-50
Involvement of the cranial nerves during the reactivation of varicella zoster virus (VZV) is known as Ramsay Hunt syndrome (RHS) and can result in paralysis of the facial muscles (cranial nerve VII) and damage to the vestibulocochlear nerve (cranial nerve VIII) with the formation of cutaneous ear vesicles. The involvement of cranial nerves other than VII and VIII sometimes occurs during the reactivation of VZV and can result in paralysis of the soft palate or vocal cords, etc. These effects typically arise from the involvement of the glossopharyngeal nerve (cranial nerve IX) or the vagus nerve (cranial nerve X). Initial symptoms can include a sore throat, hoarseness, and dysphagia, and a physical examination may reveal vesicular eruptions over various parts of pharyngolaryngeal mucosa. A pharyngolaryngoscopic examination may reveal eruptions on a unilateral side of the pharyngeal, laryngeal or epiglottic mucosa, with paralysis of the vocal cords or salivary storage in a unilateral piriform fossa. Here, we report two cases of vocal cord paralysis caused by VZV reactivation: a case with RHS and paralysis of the vocal cords, and a case with dysphagia and paralysis of the vocal cords and a sore throat as the initial symptoms.
