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Case 223: Arytenoid Dislocation.

Avi G Oppenheimer1, Vishal Gulati1, Jacobo Kirsch1

  • 1From the Departments of Radiology (A.G.O., V.G., J.K.) and Otolaryngology (G.O.A.), Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331.

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Summary
This summary is machine-generated.

A patient developed cardiogenic shock and vocal cord immobility after treatment for atrial fibrillation and lung cancer. This case highlights potential complications following intensive care, impacting voice function.

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Area of Science:

  • Cardiology
  • Pulmonology
  • Otolaryngology

Background:

  • A 71-year-old male with refractory atrial fibrillation and a history of lung cancer underwent cardioversion and rate control therapy.
  • The patient's medical history included a left upper lobectomy and atrial fibrillation unresponsive to previous treatments.

Observation:

  • The patient experienced sudden unresponsiveness and cardiogenic shock overnight, requiring emergent intubation and intensive care.
  • Complications during intensive care included ventilator-associated pneumonia and multiple failed extubation attempts over 18 days.
  • Post-discharge, the patient presented with significant hoarseness and reduced vocal volume, limiting him to a whisper.

Findings:

  • Otolaryngology evaluation revealed immobility of the right vocal cord, diagnosed via laryngoscopy and video stroboscopy.
  • The hoarseness worsened with vocal use, indicating a functional impairment of the vocal cord.
  • A computed tomographic (CT) examination of the neck was ordered to further investigate the vocal cord immobility.

Implications:

  • This case underscores the potential for serious complications, including vocal cord dysfunction, following critical illness and intensive care unit stays.
  • The findings suggest a possible link between the patient's critical care course and the observed vocal cord immobility.
  • Further investigation is warranted to determine the exact etiology and guide appropriate management, including speech therapy, for vocal cord dysfunction.