Bilateral vocal cord paralysis in Shy-Drager syndrome

A patient with a permanent tracheostomy was seen and noted to have bilateral abductor vocal cord paralysis. He was being investigated neurologically and was found to have several types of autonomic failure, specifically including postural hypotension. It was felt that he had Shy-Drager syndrome. A review of the literature showed that bilateral vocal cord paralysis is a recognized abnormality in this condition for which permanent speaking tracheostomy is the treatment of choice. Reflux esophagitis due to lax cardiac sphincter may be a factor in the laryngeal symptomatology.