RESUMEN
A unique case of acute onset vocal fold paralysis secondary to phonotrauma is presented. The cause was forceful vocalization by a drill instructor on a firearm range. Imaging studies revealed extensive intralaryngeal and retropharyngeal hemorrhage. Laryngoscopy showed a complete left vocal fold paralysis. Relative voice rest was recommended, and the patient regained normal vocal fold mobility and function after approximately 12 weeks.
Asunto(s)
Traumatismos Ocupacionales/etiología , Acústica del Lenguaje , Parálisis de los Pliegues Vocales/etiología , Pliegues Vocales/lesiones , Calidad de la Voz , Hemorragia/etiología , Humanos , Laringoscopía , Masculino , Persona de Mediana Edad , Traumatismos Ocupacionales/diagnóstico , Traumatismos Ocupacionales/fisiopatología , Recuperación de la Función , Factores de Tiempo , Tomografía Computarizada por Rayos X , Parálisis de los Pliegues Vocales/diagnóstico , Parálisis de los Pliegues Vocales/fisiopatología , Pliegues Vocales/diagnóstico por imagen , Pliegues Vocales/fisiopatologíaRESUMEN
OBJECTIVE: This report describes neurosyphilis presenting as vocal fold paresis and velopharyngeal incompetence. This represents the first reported case of neurosyphilis presenting as a vagal neuropathy since 1963. STUDY DESIGN: Case report. METHODS: Review of medical records and literature search. RESULTS: The patient presented with voice changes and nasopharyngeal reflux of liquids. Examination showed a left vocal fold paresis and moderate velopharyngeal incompetence. Laryngeal electromyography revealed evidence of denervation, and neurologic evaluation showed bilateral Adie's pupils and a positive CSF VDRL. A remote history of syphilis treated with one intramuscular injection was obtained. The patient was treated with 6 weeks of penicillin and regained normal vocal function with minimal residual intermittent hypernasality. CONCLUSIONS: Given the recent increase in the incidence of syphilis in the United States, this case serves as a reminder of the importance of including syphilis in the differential diagnosis of cranial neuropathies and the increasing likelihood of syphilis presenting to otolaryngology and speech pathology practices. Syphilis, a disease whose incidence had declined progressively for 60 years in the United States, is now resurgent and must be considered in the evaluation of patients presenting with unexplained cranial neuropathies.