Giving Voice to Cardiovocal Syndrome: A 26-Year-Old Woman With Hypophonia and Dysphagia

Abstract

Are children's hospitals only for children? Practically speaking, they and their associated specialty clinics often provide necessary medical and surgical care for patients older than 18 years, especially those with medical complexity. For this reason, pediatric practitioners must be familiar with both childhood-onset conditions and problems common in older and larger individuals. This case report describes a 26-year-old woman with CHARGE syndrome (coloboma/cranial nerve palsy, heart defects, atresia of the choanae, restricted development/growth, genitourinary abnormalities, ear abnormalities) who presented to a children's hospital with hypophonia and dysphagia and was ultimately diagnosed with left recurrent laryngeal nerve palsy due to untreated sleep apnea and uncontrolled congestive heart failure leading to pulmonary hypertension that exacerbated her congenital cardiovascular abnormalities. Her hospitalization, during which she was cared for by two Internal Medicine-Pediatrics physicians (among others), exemplifies common themes in Med-Peds practice, such as a potential mismatch of expectations, experience, equipment, and policies when adults are admitted to children's hospital, as well as an all-too-familiar lag in transitioning from pediatric to adult care for children and youth with special healthcare needs (CYSHCN).