[Dysphagia] RE: vocal fold paralysis vs arytenoid dislocation

[acellucc at bidmc.harvard.edu (acellucc@bidmc.harvard.edu)]

Karen,
It was my impression (from my colleagues who specialize in voice- which
I in no way claim) that arytenoid dislocation is something that has to
be addressed early on, or it can be 'irreversible'. Perhaps a word from
ENT to the MD team might help them realize that this could be a problem
that's fixable, but only if they don't drag their heels on it??
Just my thoughts. Alex

Message: 7
Date: Wed, 8 Mar 2006 16:05:22 -0600
From: "Copeland, Karen" <kcopeland@sjmc.org>
Subject: [Dysphagia] RE: vocal fold paralysis vs. arytenoid
	dislocation
To: <dysphagia@b9.com>
Message-ID:
	<652AA27A7C57EE448A338752349BE1982911C0@sjhsmail4.sjmc.org>
Content-Type: text/plain;	charset="US-ASCII"



I am seeking some guidance on a challenging case:

71 y.o.m ~1 mo. Post posterior fossa hemorrhage.  Ventriculostomy place
to decrease edema.  Patient was on vent for ~8 days.  Upon extubation
was aphonic and dysphagic.  Fiberoptic scope showed L vocal cord
paralysis vs. possibility of arytenoids displacement.  MBS revealed
frequent trace aspiration with liquids; cough effort was adequate at
least 50% of the time in clearing aspirated material, but I believe some
aspiration of secretions is certainly occurring.  ENT recommended a CT
of the neck to r/o the dislocation.  For some reason, the docs are
dragging their feet on this.  Here are my questions:

1)  any reason the radiation from the CT would be risky for this
gentleman at this point?  That's what one doc told him.
2)  Trial of traditional voice therapy over the past week has yielded no
perceptible changes in voice.  If the issue is dislocation with or
without VF paralysis, is voice therapy likely to be of any benefit?  My
sense is that it is not.  Doc is not happy with me for asking to defer
treatment until the CT is completed.

Thanks for any guidance.

karen