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Paralisi Bilaterale delle Corde Vocali

Un disturbo neurologico in cui il rifornimento nervoso ad entrambe le corde vocali è assente. Ciò può essere il risultato di lesioni dovute a traumi esterni, interventi chirurgici alla tiroide o traumi contundenti o penetranti al collo.

A volte l’immobilità delle corde vocali dovuta a cicatrici, ad esempio da un tubo endotracheale, viene scambiata per paralisi delle corde vocali, sebbene la distinzione sia solitamente facile da determinare, a condizione che venga eseguito un esame adeguatamente intenso e diretto. In particolare, questo workup deve includere l’anestesia topica della laringe in modo da consentire una visualizzazione estremamente ravvicinata della commissura posteriore e della sottoglottide, che può scoprire prove di cicatrici.

Guarda anche: lesione da intubazione, stenosi, sinechia delle corde vocali e paralisi unilaterale delle corde vocali

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Maximum space between cords

Maximum space between cords (1 of 2)

After thyroidectomy many years earlier, the patient’s exercise tolerance became minimal without becoming short of breath and making loud inspiratory vocal sounds. Eventually, she underwent tracheotomy, which she has continued to wear for more than ten years. This view shows the maximum space between her vocal cords, which paradoxically occurs when she exhales.
View during inhalation

View during inhalation (2 of 2)

When asked to inhale with tracheotomy tube momentarily plugged, the passing air causes the vocal cords to indraw slightly and come into vibration, creating “involuntary inspiratory phonation.” Note the faint convexity and grey blur where the mucosa is vibrating.

Inspirazione della mucosa con ispirazione

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Paralyzed vocal cord

Paralyzed vocal cord (1 of 2)

Paralyzed right vocal cord, with bowing and atrophy. Here, the left vocal cord is maximally but incompletely abducted. Subtle markings are for reference with photo 2.
Indrawing with inspiration

Indrawing with inspiration (2 of 2)

With elicited inspiration, the mucosa of the undersurface of both vocal cords indraws due to Bernouilli effect/ micro-vortices and further narrows the airway. At the same time, the patient involuntarily makes inspiratory voice.