A Case of Bilateral Vocal Fold Paralysis Induced by Concurrent Rheumatoid Arthritis Involvement of Laryngeal Nerve and Cricoarytenoid Joint

윤상피열관절과 후두신경을 동시에 침범하여 양측성대마비를 유발한 류마티스 관절염 1예

  • Park, Yun Hwi (Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine) ;
  • Kim, Han Su (Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine) ;
  • Jung, Sung Min (Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine) ;
  • Jung, Soo Yeon (Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine)
  • 박윤희 (이화여자대학교 의과대학 이비인후과학교실) ;
  • 김한수 (이화여자대학교 의과대학 이비인후과학교실) ;
  • 정성민 (이화여자대학교 의과대학 이비인후과학교실) ;
  • 정수연 (이화여자대학교 의과대학 이비인후과학교실)
  • Received : 2016.10.20
  • Accepted : 2016.11.04
  • Published : 2016.12.30

Abstract

Rheumatoid arthritis (RA) is a connective tissue disease involving the larynx in 30 % of the patients. Foreign body sensation, hoarseness, and cough are common symptoms in laryngeal involvement. An urgent tracheostomy is required when acute airway obstruction occurs in case of bilateral vocal fold paralysis. The most common cause of bilateral vocal fold paralysis in RA patients is a cricoarytenoid joint arthritis. Laryngeal nerve degeneration is rare cause of bilateral vocal fold paralysis in RA patients. In this case report, an emergent tracheostomy was performed on a 64-years-old male patient with acute dyspnea, and concurrent involvement of RA on laryngeal nerve and cricoarytenoid joint was revealed by laryngeal electromyography and histopathology. The vocal fold mobility was restored after 3-months medical treatment.

Keywords

References

  1. Kim TW, Son YI. Management Principles of Bilateral Vocal Fold Immobility. J Korean Society Laryngol Logopedics Phoniastrics 2009;20(2):118-25.
  2. Sapundzhiev N, Lichtenberger G, Eckel HE. Surgery of adult bilateral vocal fold paralysis in adduction: history and trends. Eur Arch Otorhinolaryngol 2008;265:1501-14. https://doi.org/10.1007/s00405-008-0665-1
  3. Papadimitraki ED, Kyrmizakis DE, Kritikos I, Boumpas DT. Earnose-throat manifestations of autoimmune rheumatic diseases. Clin Exp Rheumatol 2004;22(4):485-94.
  4. Berjawi G, Uthman I, Mahfoud L, Husseini ST, Nassar J, Kotobi A, et al. Cricothyroid joint abnormalities in patients with rheumatoid arthritis. J Voice 2010;24(6):732-7. https://doi.org/10.1016/j.jvoice.2009.06.005
  5. Vikas A, Ram S, Wiclaf, Sandeep C. A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol 2008;27:841-4. https://doi.org/10.1007/s10067-007-0804-x
  6. Lee EJ, Joo YH, Kim JP, Woo SH. A Case of Bilateral Vocal Cord Paralysis in a Patient with Rheumatoid Arthritis. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:235-8. https://doi.org/10.3342/kjorl-hns.2011.54.3.235
  7. Ahn CM, Moon KJ, Kim HC. Rheumatoid Arthritis of the Larynx: A Case Report. Korean J Otolaryngol 2002;45:522-5.
  8. MacKenzie M. Disease of the pharynx, larynx, and trachea. 1st ed. New York: William Wood;1880. p.347.
  9. Jurik AG, Pedersen U. Rheumatoid arthritis of the crico-arytenoid and crico-thyroid joints: a radiological and clinical study. Clin Radiol 1984;35:233-6. https://doi.org/10.1016/S0009-9260(84)80146-4
  10. Lawry GV, Finerman ML, Hanafee WN, Mancuso AA, Fan PT, Bluestone R. Laryngeal involvement in rheumatoid arthritis: a clinical, laryngoscopic, and computerized tomographic study. Arthritis Rheum 1984;27:873-82. https://doi.org/10.1002/art.1780270806
  11. Lofgren RH, Montgomery WW. Incidence of laryngeal involvement in rheumatoid arthritis. N Engl J Med 1962;267:193-95. https://doi.org/10.1056/NEJM196207262670407
  12. Simpson GT 2nd, Javaheri A, Janfaza P. Acute cricoarytenoid arthritis: local periarticular steroid injection. Ann Otol Rhinol Laryngol 1980;89(6 Pt 1):558-62. https://doi.org/10.1177/000348948008900615
  13. Park SH. Treatment of Rheumatoid Arthritis Guidelines. Korean J Intern Med 2010;79(2):455-458.
  14. Darke CS, Wolman L, Young A. Laryngeal stridor in rheumatoid arthritis. Br Med J 1958;1:1279-82. https://doi.org/10.1136/bmj.1.5082.1279
  15. Chung SM. Laryngeal electromyography. J Korean Society Laryngol Logopedics Phoniastrics 2006;17(1):1-13.