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Bilateral Vocal Cord Palsy Secondary to Rheumatoid Arthritis.
Liam D Hyland1, Rachel Saville2, Nada Dwiddar1
1Otolaryngology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR.
Cureus
|February 9, 2024
Summary
Rheumatoid arthritis can cause laryngeal issues, including vocal cord fixation leading to inspiratory stridor. This case highlights a rare, late complication of RA presenting as acute airway obstruction.
Area of Science:
- Otolaryngology
- Rheumatology
- Pulmonology
Background:
- Rheumatoid arthritis (RA) is a chronic inflammatory disorder.
- Laryngeal manifestations can occur in RA, though airway emergencies are rare.
- Vocal cord fixation is a late complication of RA, potentially causing inspiratory stridor.
Observation:
- An 85-year-old female presented with acute stridor, tachypnea, and drowsiness.
- Nasendoscopy revealed bilateral vocal cord fixation and adduction due to cricoarytenoid joint involvement, indicative of RA.
- The patient experienced a similar, less severe episode 18 months prior, also attributed to RA.
Findings:
- The patient presented with hypercapnic respiratory failure and signs of infection.
- Non-invasive ventilation stabilized the patient, but long-term surgical options were deemed unsuitable.
- A palliative care approach was adopted after withdrawal of ventilatory support.
Implications:
- Acute stridor secondary to RA-induced vocal cord palsy is a life-threatening complication.
- Management requires careful consideration of the patient's clinical status and quality of life.
- Surgical interventions like tracheostomy or glottis-enlarging procedures may be options but must be carefully evaluated.
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