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Vagus nerve laryngeal paralysis — Clinical Guidelines

Overview

Vagus nerve laryngeal paralysis, including unilateral laryngeal and lingual paralysis (Tapia syndrome), involves dysfunction of the recurrent laryngeal nerve (RLN) and hypoglossal nerve, leading to symptoms such as dysphagia, dyspnea, and voice alteration following surgical interventions like thyroidectomy.

Diagnosis

Clinical Presentation: Ipsilateral paralysis of the vocal cord and tongue, presenting with dysphagia, dyspnea, and voice changes 1.

Diagnostic Tests:

- Videolaryngostroboscopy: Evaluates vocal fold movement and function 4. - Laryngeal Electromyography (LEMG): Provides objective assessment of laryngeal muscle activity 4. - Aerodynamic Assessment: Evaluates voice production parameters 4. - Photoglottography and Electroglottography: Offer detailed insights into vocal fold vibration patterns 6 7.

Management

Speech Therapy: Early initiation of logopedic rehabilitation is crucial for recovery of swallowing and phonation 1 3.

Timing of Therapy: Initiating voice therapy within 3 months post-onset shows significant improvements in voice quality 3.

Surgical Intervention: Considered for severe functional deficits such as aspiration pneumonia, disabling voice changes, or significant dyspnea 4.

Intraoperative Monitoring: Utilize intraoperative electrophysiologic monitoring (IONM) of the RLN to minimize nerve damage during surgery 2.

Special Populations

No Specific Guidelines: Abstracts do not provide detailed recommendations specific to pregnancy, pediatrics, elderly, or comorbidities 1 2 3 4 5 6 7.

Key Recommendations

Initiate Early Speech Therapy: Early logopedic rehabilitation should be started to prevent permanent functional deficits and to facilitate recovery 1 3 (Evidence: Strong).

Utilize Intraoperative Monitoring: Implement intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve to reduce surgical complications 2 (Evidence: Moderate).

Timely Voice Therapy: Begin voice therapy within 3 months of symptom onset to achieve significant improvements in voice quality 3 (Evidence: Moderate).

References

1 De Luca P, Cavaliere M, Scarpa A, Savignano L, Cassandro E, Cassandro C et al.. Rehabilitation Protocol for Unilateral Laryngeal and Lingual Paralysis (Tapia Syndrome): Comment About "A Challenging Case of Tapia Syndrome After Total Thyroidectomy" By Ildem Deveci, Mehmet Surmeli, and Reyhan Surmeli. Ear, nose, & throat journal 2021. link 2 Macias AA, Eappen S, Malikin I, Goldfarb J, Kujawa S, Konowitz PM et al.. Successful intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve, a multidisciplinary approach: The Massachusetts Eye and Ear Infirmary monitoring collaborative protocol with experience in over 3000 cases. Head & neck 2016. link 3 Cantarella G, Viglione S, Forti S, Pignataro L. Voice therapy for laryngeal hemiplegia: the role of timing of initiation of therapy. Journal of rehabilitation medicine 2010. link 4 Finck C. Laryngeal dysfunction after thyroid surgery: diagnosis, evaluation and treatment. Acta chirurgica Belgica 2006. link 5 Eckley CA, Sataloff RT, Hawkshaw M, Spiegel JR, Mandel S. Voice range in superior laryngeal nerve paresis and paralysis. Journal of voice : official journal of the Voice Foundation 1998. link80024-6) 6 Trapp TK, Berke GS. Photoelectric measurement of laryngeal paralyses correlated with videostroboscopy. The Laryngoscope 1988. link 7 Hanson DG, Gerratt BR, Karin RR, Berke GS. Glottographic measures of vocal fold vibration: an examination of laryngeal paralysis. The Laryngoscope 1988. link

Vagus nerve laryngeal paralysis