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Anesthesia

Vocal Cord Injury

12/12/2008

Question:

I realize that this question should be sent to an ENT doctor but your site says that the ENT doctors are not currently answering questions so I am hoping that you might be able to give me your opinion. I recently had knee surgery (eight weeks ago). The usual horsness was still there and affecting my voice a week later when visiting my orthopedic surgeon and he said it should go away. I did contact my anesthesiologist and he said he didn`t notice any problems doing the trac. When it continued, I went to an ENT who put a camera through my nose and into my throat. She saw that I had a scratch on my right vocal cord back near the "v" which we can assume was done by the tube that was put down my throat since I had no problem before going into surgery. The good news was that both cords were moving. She put me on a round of prednazone (sp). Two weeks later, there was no noticable improvement. She has now referred me to a Voice Specialist. I can speak relatively well first thing in the morning but as the day goes by my voice gets raspier and by evening it is hard to talk. It`s nearly impossible to carry on a conversation over the telephone. I can whisper with no problem but I am getting worried. My ENT first told me that she didn`t think it was a long term injury but now that it`s been eight weeks and my appointment with the new doctor is not for another ten days I`m searching for any information I can find. I know you can`t diagnois without actually seeing the problem and that you are an anesthesiologist but is there any encouraging information you can give me in this area? I would greatly appreciate any thing you might be able to tell me. This is a life changing experience for me as I need my voice not only in my personal life but, as in most cases, my work. Quite naturally, I am praying for this injury to heal. Thank you.

Answer:

I can understand your concern, but unfortunately I cannot shed much light on your current condition. All I can say is it sounds as though you had a minor vocal cord injury during intubation (not "trac" as you put it - that is usually an abbreviation for tracheostomy). Most of these injuries do heal and the vocal cords recover. Minor vocal cord injuries can occur even when the intubation appears to go smoothly. I don't have any prognostic information or predictions to make about your recovery - this is best discussed with your ENT doctor and your speech therapist.

The fatigue you experience when using your voice during the day suggests to me that there might be something else neurologic going on that may or may not be related to the original injury. This idea is not meant to increase your anxiety but when things don't go as expected it is best to keep an open mind on the underlying cause. Again that is best discussed with your own doctors.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University