Vocal cord palsy during sleep is strongly associated with Multiple System Atrophy (MSA) and sometimes results in sudden death due to airway obstruction. Nasal continuous positive airway pressure (nCPAP) is a recommended therapy since it can increase the patency of a closed airway due to vocal cord palsy. In this study, I described the motion of the vocal cords of MSA patients using a specialized MRI that runs silently. Several papers reported that there were combinations of upper airway obstructions and pharyngeal obstructions before vocal cord palsy. In addition, it was reported that a tracheotomy would be necessary in cases of bilateral vocal cord palsy in awakened states, and that the prognosis of MSA is still difficult after a tracheotomy because of the increase of central sleep apnea. MSA is one of the most difficult diseases to treat due to the various combinations of upper airway obstructions, coexistent obstructions and central sleep apnea⁄hypopnea. As otolaryngologists, we should recognize the difficulty in managing MSA and consider better treatments for MSA than current ones.
