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Is Vocal Cord Paralysis Related To Edema? Have Dysphagia After Lumbar Surgery With Intubation.
Question: Yesterday I contacted you regarding my husband's dysphagia and vocal cord paralysis. Had lumbar surgery 2 weeks ago with intubation. Today he had a barium swallow..the radiologist told him that there is definitely something there..it's.not new...called it .edema and he did not see indications of a tumor. Test ordered by ENT . Radiologist also wanted to send report to our
GI specialist. What conditions do these findings indicate,( if not a tumor). Is the Vocal Cord paralysis related or s separate issue?
GI specialist. What conditions do these findings indicate,( if not a tumor). Is the Vocal Cord paralysis related or s separate issue?
Would the edema he saw cover up a tumor?
Hi
Thanks for writing back
The radiologist has given a vague report, the doctor does not precisely mention about where exactly the edema or the swelling is situated and its appearance. Without knowing the location and the features of the radiological finding it is indeed difficult to make a diagnosis.
If we analyze the history closely, your husband never had this problem before surgery, which means there was no swelling or the tumor before surgery. The vocal cord palsy has been noted only after surgery which indicates either traumatic dislocation of the arytenoids following surgery or swelling in the prevertebral region secondary to the compression of the endotracheal tube over the vertebral bodies (which happens in case of cervical spondylosis). Also there is a possibility of blood clot formation in the brain following anesthesia which would have caused neuro-vascular injury to the nucleus of the nerve (vagus nerve)supplying to the vocal cords leading to paralysis of the vocal cord and hence dysphagia.
If your husband had vocal cord paralysis prior to the surgery, then he would have definitely suffered from hoarseness and dysphagia before. But in this case, it did not happen so, thus it clearly shows that the dysphagia has developed only after endotracheal intubation which could be more likely of traumatic etiology.
To confirm whether it is mere edema in the larynx or a tumor, it would be better to get an MRI of the neck done. MRI will provide an accurate picture of the soft tissue and neurological lesions in the neck.
Hope you are convinced with this answer; I will be available for the follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Thanks for writing back
The radiologist has given a vague report, the doctor does not precisely mention about where exactly the edema or the swelling is situated and its appearance. Without knowing the location and the features of the radiological finding it is indeed difficult to make a diagnosis.
If we analyze the history closely, your husband never had this problem before surgery, which means there was no swelling or the tumor before surgery. The vocal cord palsy has been noted only after surgery which indicates either traumatic dislocation of the arytenoids following surgery or swelling in the prevertebral region secondary to the compression of the endotracheal tube over the vertebral bodies (which happens in case of cervical spondylosis). Also there is a possibility of blood clot formation in the brain following anesthesia which would have caused neuro-vascular injury to the nucleus of the nerve (vagus nerve)supplying to the vocal cords leading to paralysis of the vocal cord and hence dysphagia.
If your husband had vocal cord paralysis prior to the surgery, then he would have definitely suffered from hoarseness and dysphagia before. But in this case, it did not happen so, thus it clearly shows that the dysphagia has developed only after endotracheal intubation which could be more likely of traumatic etiology.
To confirm whether it is mere edema in the larynx or a tumor, it would be better to get an MRI of the neck done. MRI will provide an accurate picture of the soft tissue and neurological lesions in the neck.
Hope you are convinced with this answer; I will be available for the follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by :
Dr. Yogesh D
Is it possible that a small lesion existed and the intubation aggravated the area which in return created the edema and onset of dysphagia?
Hi,
Thanks for the follow up.
It is very unlikely for a small lesion to exist which could flare up following intubation. To explain more about this:
1). If there existed a lesion in the post cricoid region (the area of entry into the esophagus), your husband would have had sensation of lump in the throat, which was not noticed before.
2). In case of lesion in the vocal cords, there would have been hoarseness.
3). Any mass in the sub-glottic region (the region below vocal cords) he would have developed difficulty in breathing.
4) The only chances of the lesion to exist could be the supra-glottic region (the region above the vocal cords), as it is a wide spread area and small lesions in this area will usually go unnoticed, until it is big enough to cause symptoms. But even in this case an Indirect Laryngeal Examination can identify the lesion in the post-operative period.
Intubation is done into the trachea and it is very unlikely for the tube to have traumatized the lesion following which there would be swelling, enough to cause dysphagia.
Whatever has happened till now, it is very difficult to explain without a complete set of investigations. I would still recommend getting an MRI( Magnetic Resonance Imaging) of the neck done to locate the site of the lesion and also the type of lesion.
Wishing you good health.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Thanks for the follow up.
It is very unlikely for a small lesion to exist which could flare up following intubation. To explain more about this:
1). If there existed a lesion in the post cricoid region (the area of entry into the esophagus), your husband would have had sensation of lump in the throat, which was not noticed before.
2). In case of lesion in the vocal cords, there would have been hoarseness.
3). Any mass in the sub-glottic region (the region below vocal cords) he would have developed difficulty in breathing.
4) The only chances of the lesion to exist could be the supra-glottic region (the region above the vocal cords), as it is a wide spread area and small lesions in this area will usually go unnoticed, until it is big enough to cause symptoms. But even in this case an Indirect Laryngeal Examination can identify the lesion in the post-operative period.
Intubation is done into the trachea and it is very unlikely for the tube to have traumatized the lesion following which there would be swelling, enough to cause dysphagia.
Whatever has happened till now, it is very difficult to explain without a complete set of investigations. I would still recommend getting an MRI( Magnetic Resonance Imaging) of the neck done to locate the site of the lesion and also the type of lesion.
Wishing you good health.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Radhika
Answered by
Dr. Naveen Kumar Nanjasetty
Otolaryngologist / ENT Specialist
Practicing since :2001
Answered : 2540 Questions
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