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Suggest treatment for vocal cord palsy

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Posted on Sat, 30 May 2015
Question: My wife had problem with change of voice and difficulty in speaking (hoarseness) we consulted ENT Specialist and he suggested us to get Scan reports for Thyroid, TFT, some lab test related to Thyroid (collected some mass from Thyriod gland by injecting needle) after seeing the lab reports doctor diagnosed it as Vocal cord Palsy and prescribed her Methicoplus Tab along with Thyroxin 25 mcg Tab.
After the treatment she got completely cured and able to speak normally, T3 ,T4 & TSH all under control with in 3 to 4 months. But again now the problem started... disturbance in her voice (hoarseness) and not able to speak normally. It’s become on and off problem to her.
Please advise us to get rid of this problem.

doctor
Answered by Dr. Naveen Kumar (8 hours later)
Brief Answer:
Please mail us the previous investigations reports

Detailed Answer:
Hi

Thanks for posting the query. I have gone through the history thoroughly and understood the problem. I'll try my best to help you with this.

The causes of hoarseness in an young adult female are many. To mention a few,
1. Acid reflux disease
2. Allergy
3. Recurrent sinusitis
4. Voice abuse
5. Benign lesions of the vocal cords, etc.

As your doctor has evaluated your wife completely and mentioned that she had vocal cord palsy. My doubt is, what was the cause of vocal cord palsy, as mentioned by your doctor?

Apart from blood tests and FNAC of the thyroid, whether any other tests such as MRI or CT Scan of the brain and neck was performed.

Is it possible for you to mail us the reports of the previous investigations. It would be very helpful to find out the cause and aid in further management.

Awaiting for your reply...

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Naveen Kumar (2 days later)

Dear Dr. Uploaded / Attached Ct scan and cytology reports. Kindly go through the same. We will be eagerly waiting for your feed back. Thanks and regards
doctor
Answered by Dr. Naveen Kumar (28 hours later)
Brief Answer:
Consult a Gen. Surgeon or Head & Neck Surgeon and get FNAC done...

Detailed Answer:
Hi

Thanks for posting the reports and I sincerely apologize for the delay in answering the query.

I have gone through the report thoroughly and understood the problem. To explain to you in detail:
1. The prime cause of hoarseness is the compression of the hardened segment of the thyroid nodule on the recurrent laryngeal nerve. An important structure which helps in the motion of the vocal cords. Hence, in the initial stages of the treatment the compression over the nerve was relieved with medicines. Now the swelling would have increased in the size, thus causing pressure over the nerve and inducing hoarseness.

2. CT scan report says there are pre-tracheal lymph nodes, which are calcified (hardened). Lymph nodes are like policemen of our body which enlarges when there is infection or inflammation in the surrounding region. Calcified nodes makes me suspicious; malignancy has to be ruled out.

3. Hence, keeping in the mind the possibility of malignancy, I would suggest you consult an apt Head & Neck Surgeon or General Surgeon at your place. A fine need aspiration cytology (FNAC) of the calcified thyroid nodule is required to identify the cause and type of problem.

4. Meanwhile, continue the medicines prescribed by your doctor.

Hope this answers your query; revert back to me if you have any follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Naveen Kumar (3 days later)
Dear Dr. Yes, we did FNAC for thyroid nodule and there is no sign of Malignancy. They mentioned it as "BENIGN"... The report copy is not readily available with me, as i am out of country and FNAC report will be forwarded to you on 11th May 2015.

But i clearly remember that they have reported it as " BENIGN".

I also have to inform you that the situation is better now and she slowly gaining the voice and hoarseness is getting reduced day by day.
Now .. how do we interpret this condition.

doctor
Answered by Dr. Naveen Kumar (41 hours later)
Brief Answer:
Surgical excision of the mass compressing the nerve is the best option

Detailed Answer:
Hi

Thanks for writing back

It's a good news that the calcified mass is a benign harmless lesion.

The recurrent hoarseness is due to compression of the recurrent laryngeal nerve by the calcified mass. Administration of medicines such as betnesol reduces the pressure effects on the nerve. But, once the medicine effects weans off, the hoarseness recurs.

Hence, I personally feel it would be wiser to remove the mass compressing over the nerve rather than administering steroids on and off.

Hope this clarifies your doubts. Wish your wife good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Naveen Kumar

ENT Specialist

Practicing since :2001

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Suggest treatment for vocal cord palsy

Brief Answer: Please mail us the previous investigations reports Detailed Answer: Hi Thanks for posting the query. I have gone through the history thoroughly and understood the problem. I'll try my best to help you with this. The causes of hoarseness in an young adult female are many. To mention a few, 1. Acid reflux disease 2. Allergy 3. Recurrent sinusitis 4. Voice abuse 5. Benign lesions of the vocal cords, etc. As your doctor has evaluated your wife completely and mentioned that she had vocal cord palsy. My doubt is, what was the cause of vocal cord palsy, as mentioned by your doctor? Apart from blood tests and FNAC of the thyroid, whether any other tests such as MRI or CT Scan of the brain and neck was performed. Is it possible for you to mail us the reports of the previous investigations. It would be very helpful to find out the cause and aid in further management. Awaiting for your reply... Regards Dr. Naveen Kumar N ENT and Head & Neck Surgeon