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Microscopic bilateral posterior cordotomy in severe obstructive sleep apnea syndrome with bilateral vocal cord paralysis

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Abstract

Background

Vocal cord paralysis is a rare cause of obstructive sleep apnea syndrome (OSAS). Recurrent laryngeal nerve injury after thyroid gland surgery is one of the leading causes of acquired vocal cord paralysis.

Report

A 46-year-old woman with OSAS due to bilateral abductor vocal cord paralysis was presented. She had thyroidectomy 30 years ago and had a weak, breathy voice. She had been referred with a history of high-pitched snoring, apnea witnessed by her spouse, and excessive daytime sleepiness for the last 5 years. Full-night polysomnography revealed that her apnea–hypopnea index was 72/h and minimal oxygen saturation level was 81%. There was no REM and deep sleep periods. Ear–nose–throat consultation offered an endoscopic bilateral posterior cordotomy operation via microscopic suspension laryngoscopy (MLS) as a treatment option.

Conclusions

Instead of using a nasal positive airway pressure (nCPAP) device, she was treated surgically. Her OSAS resolved completely within 5 months of the surgery. Her phonation was preserved, and symptoms such as snoring and hypersomnolance disappeared. In OSAS patients with bilateral vocal cord paralysis, MLS-associated bilateral posterior cordotomy can be a choice of treatment as an alternative to nCPAP application.

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Abbreviations

OSAS:

Obstructive sleep apnea syndrome

PSG:

Polysomnography

AHI:

Apnea–hypopnea index

MLS:

Microscopic suspension laryngoscopy

REM:

Rapid eye movements

nCPAP:

Nasal continuous positive airway pressure

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Pulmonary Diseases, Maltepe University, Istanbul, Turkey

    Nesrin Sarıman, Ender Levent, Akın Cem Soylu, Sümeyye Alparslan & Attila Saygı

  2. Faculty of Medicine, Department of Ear Nose Throat, Maltepe University, Istanbul, Turkey

    Öncel Koca & Zerrin Boyacı

  3. Pulmonary Diseases Department, Maltepe Medical Faculty Hospital, İstanbul, Turkey

    Nesrin Sarıman

  4. Tıp Fakültesi Hastanesi, Göğüs Hastalıkları Anabilim Dalı, Maltepe Üniversitesi, Feyzullah Cad.No:39 Maltepe, Istanbul, Turkey, 34843

    Nesrin Sarıman

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  1. Nesrin Sarıman
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  2. Öncel Koca
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  3. Zerrin Boyacı
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  4. Ender Levent
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  5. Akın Cem Soylu
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  7. Attila Saygı
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Corresponding author

Correspondence to Nesrin Sarıman.

Additional information

We plan to make a poster presentation of the case at a national congress about respiratory diseases. It is not yet determined.

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Sarıman, N., Koca, Ö., Boyacı, Z. et al. Microscopic bilateral posterior cordotomy in severe obstructive sleep apnea syndrome with bilateral vocal cord paralysis. Sleep Breath 16, 17–22 (2012). https://doi.org/10.1007/s11325-010-0458-9

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  • DOI: https://doi.org/10.1007/s11325-010-0458-9

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