407 - Speech Therapy for Unilateral Vocal Cord Paralysis Following Carotid Endarterectomy Complicated by a Large Neck Hematoma: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

RC

Roberto F. Cordero, DO

Transitional Year Resident Physician
University of South Florida/HCA Florida Bayonet Point Hospital
New Port Richey, Florida, United States

Co-Author(s)

AH

Alekh M. Hira, MD

Physical Medicine & Rehabilitation Medical Director
HCA Florida Bayonet Point Hospital
Hudson, Florida, United States
FG

Francia E. Guerrero, MD

Transitional Year Residency Program Director
University of South Florida/HCA Bayonet Point Hospital
Hudson, Florida, United States

Case Diagnosis: Vocal cord paralysis secondary to right recurrent laryngeal nerve injury following carotid endarterectomy complicated by a large neck hematoma.

Case Description: A 78-year-old female is transferred from a nearby hospital after undergoing a right carotid endarterectomy complicated by a large neck hematoma a few days later. Prior to urgent neck evacuation, the patient developed cough, dysphagia, and dysphonia symptoms. An otolaryngologist utilized a flexible nasolaryngoscopy to evaluate her vocal cords. She was found to have right vocal cord paralysis in the paramedian position. Concomitantly, the patient had other cardiac procedures performed for her comorbidities. The patient was admitted to inpatient rehab after being stabilized in the ICU. She underwent daily speech therapy, including oral motor exercises, proper oral hygiene, nutrition, and speech strategies. The patient was discharged home after meeting all her therapy goals.

Discussions: Carotid endarterectomy complications occasionally include large neck hematomas necessitating surgical evacuation, which, if undetected, can lead to respiratory compromise. Injury to adjacent structures, such as the recurrent laryngeal nerve (RLN), can cause vocal cord dysfunction through nerve stretching or arterial supply compression. Symptoms may encompass changes in voice pitch, tone, and volume, along with dysphagia. In cases where the RLN is not transected, voice therapy is a treatment option, while others may require surgical intervention.

Conclusions: Post-operative RLN injury significantly impacts activities of daily living and instrumental activities of daily living. Familiarity with the clinical symptoms is essential, as presentation can vary. Early diagnosis by an otolaryngologist and prompt intervention by a speech therapist can substantially influence prognosis. This case illustrates the benefits of early detection and therapy, leading to marked improvement during this patient’s rehabilitation course and highlighting the importance of interdisciplinary collaboration in such cases.