Airway compromise secondary to vagus nerve stimulator: case report and implications for otolaryngologists.
BACKGROUND
Vagus nerve stimulators are devices used in the management of patients with drug-refractory epilepsy unsuitable for resective or disconnective surgery. Implanted usually by neurosurgeons, these devices are infrequently encountered by otolaryngologists. Despite significant anti-seizure efficacy, side effects related to laryngopharyngeal stimulation are not uncommon.


METHODS
A 28-year-old man with a history of effective vagus nerve stimulator use presented with a cluster of seizures and respiratory distress associated with intermittent stridor. The duration of stridor corresponded to the period of vagus nerve stimulation. Endoscopy revealed forced adduction of the left vocal fold against a medialised right vocal fold. The device was switched off and the stridor immediately resolved.


CONCLUSIONS
Airway compromise is an under-recognised side effect of vagus nerve stimulation. We describe the first known case of stridor and contralateral vocal fold palsy in a vagus nerve stimulator user. We highlight the need for better understanding amongst otolaryngologists of the laryngopharyngeal side effects of this technology.
Department of Otorhinolaryngology Head and Neck Surgery, Royal Blackburn Hospital, Blackburn, UK.
Y M
YM
Bhatt
P S
PS
Hans
A
A
Belloso
D000328:Adult; D000402:Airway Obstruction / Q000209:etiology; D004827:Epilepsy / Q000628:therapy; D006801:Humans; D008297:Male; D010036:Otolaryngology; D012135:Respiratory Sounds / Q000209:etiology*; D055536:Vagus Nerve Stimulation / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000209:etiology