Vocal Fold Paralysis as a Delayed Consequence of Neck and Chest Radiotherapy.
OBJECTIVE
To describe a series of cases of vocal fold paralysis years after radiation therapy, including presentation, clinical course, and treatment.


METHODS
Case series with chart review.


METHODS
Tertiary care center.


METHODS
A review of 8 years of patient records yielded 10 patients (8 male and 2 female; average age 57 years [range, 29-76 years]) with vocal fold paralysis and a history of radiation therapy to the head, neck, or mediastinum. These patients did not have other possible etiologies of vocal fold paralysis. Demographic, diagnostic, clinical course, and treatment data were collected.


RESULTS
On average, 21 years (range, 1-27 years) elapsed between completion of radiation and presentation with vocal fold paralysis. Original pathologies included Hodgkin lymphoma (5), squamous cell carcinoma of the head and neck (4), and peripheral T-cell lymphoma (1). Eight patients had unilateral left vocal fold paralysis, and 2 had bilateral neuropathy; none recovered spontaneously. All patients had dysphonia, and nearly all patients also complained of dysphagia. Six elected not to be treated. Four underwent injection augmentation with resolution of voice complaints.


CONCLUSIONS
Radiation therapy has the potential to cause laryngeal neuropathy years to decades after treatment. The potential for recovery is low, but injection augmentation can relieve symptoms. Development of contralateral neuropathy and altered tissue response are considerations in treatment.
Department of Otolaryngology, Loma Linda University Health, Redlands, California, USA bcrawley@llu.edu.
Brianna K
BK
Crawley
Department of Otolaryngology-Head & Neck Surgery, The Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA.
Lucian
L
Sulica
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006689:Hodgkin Disease / Q000532:radiotherapy; D006801:Humans; D016399:Lymphoma, T-Cell / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014826:Vocal Cord Paralysis / Q000209:etiology*; D014827:Vocal Cords / Q000528:radiation effects
delayed cranial neuropathy; laryngeal neuropathy; radiation therapy; vocal fold injection; vocal fold paralysis