An Unusual Form of Laryngeal Paralysis Associated with Arnold-Chiari Malformation

Abstract

This paper alerts the otolaryngologist to a previously unreported type of laryngeal paralysis (adductor type) in association with the Arnold-Chiari malformation. A survey of the literature fails to reveal any similar documented cases of absent laryngeal sensory function in association with this neurological defect. All prior reports have dealt with abductor laryngeal paralysis associated with the Arnold-Chiari malformation in which airway obstruction was the predominant laryngeal symptom. In the patient reported here, aspiration was the predominant symptom and was due to total loss of laryngeal sensation. This report describes this patient's clinical findings in detail, reviews the literature, and discusses management.

Abductor vocal fold palsy as a manifestation of type one Arnold Chiari malformation

“…This response was absent in our patient, although adduction was voluntarily present during phonation. A review of the world literature by Birns 3 in 1984, and a thorough review of all subsequent literature demonstrates over 120 cases of laryngeal dysfunction associated with ACM and/or meningomyeocoele, with only one other documented case of absent laryngeal sensation as the initial presentation. This was in a newborn child with associated Chiari type II malformation.…”

“…This is the rst documented presentation in this manner in an adult. Birns 3 reported one similar paediatric case in America in 1984, with absent laryngeal sensation associated with a type II Chiari malformation. Other reports describe signi cant aspiration associated with ACM, that may have been attributable to diminished laryngeal sensation, but are poorly documented.…”

Airway Abnormalities in Patients with Arnold‐Chiari Malformation

“…Preoperative signs that may indicate poor prognosis include duration of symptoms greater than 24 months, muscle atrophy, ataxia, nystagmus, trigeminal hypesthesia, and dorsal column dysfunction. 9 Manifestations of vocal cord impairment may range from abductor palsy, 2 adductor palsy, 15 or paralysis to paradoxical vocal cord movement. 16 Other neurologic deficits may occur in combination with the vocal cord impairment and they may be temporally related to the increased intracranial pressure.…”

“…Manifestations of vocal cord impairment may range from abductor palsy, 2 adductor palsy, 15 or paralysis to paradoxical vocal cord movement 16 . Other neurologic deficits may occur in combination with the vocal cord impairment and they may be temporally related to the increased intracranial pressure 3 .…”

Chiari Type I malformation and upper airway obstruction in adolescents

“…Chiari I malformation otolaryngologic manifestations tion involve abductor vocal fold paralysis, but a rare case of adductor vocal fold palsy in Chiari malformation has been described[15].…”