title: [When should tracheotomy be performed in bilateral vocal cord paralysis involving multiple system atrophy?].
abstract: OBJECTIVE
  Bilateral vocal cord paralysis caused by central nervous system dysfunction results from such diverse causes as cerebrovascular disorder and neurodegenerative disease. Otolaryngologists are often consulted about indications of tracheostomy for such cases, but if their recognition of causative disease is insufficient, it is difficult to judge indications of tracheostomy. We reviewed tracheostomy cases due to bilateral vocal cord paralysis caused by multiple system atrophy (MSA) and considered points to keep in mind in such cases.
  
  
  METHODS
  We diagnosed 9 cases of vocal cord midline fixation due to central bilateral vocal cord paralysis caused by MSA and treated by tracheostomy. We reviewed clinical conditions and suitable time for tracheostomy because it presents a specific clinical course.
  
  
  RESULTS
  7 cases were MSA-P and 2 cases were MSA-C. Inspiratory stridor in awaking and dysphasia was aggravated at the almost same time in 7 cases.
  
  
  CONCLUSIONS
  Vocal cord abductor paralysis in MSA may cause sudden death, but when an otolaryngologist not familiar with this disease is asked for air way evaluation, it is possible to be diagnosed as no vocal cord paralysis because there is no an adductor disorder, so clinical course of MSA should be clarified more. In vocal cord midline fixation, it was expected that intervention by hypermyotony in the progress of Parkinsonism was a main factor, as was vocal cord abductor disorder due to a neurogenic change in the posterior cricoarytenoid muscle in MSA. The aggravation of dysphasia is an important index in judging the indication of tracheostomy.
authors.affiliation: Department of Otolaryngology, Tokyo Metropolitan Geriatric Hospital, Tokyo.
authors.forename: Yurika
authors.initials: Y
authors.lastname: Kimura
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Sugiura
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ohmae
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Kato
authors.forename: Seiji
authors.initials: S
authors.lastname: Kishimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications*; D013997:Time Factors; D014140:Tracheotomy; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000601:surgery*