Ortner's syndrome: A systematic review of presentation, diagnosis and management

Abstract

Ortner's syndrome, cardiovocal syndrome, hoarseness Ortner's syndrome (OS), also called cardiovocal syndrome, is a rare condition hallmarked by left recurrent laryngeal nerve palsy due to underlying cardiopulmonary disease. The purpose of this review is to systemically analyze the existing literature for cases of OS to outline typical presentation, methods of diagnosis, and management of these patients. Case reports, case series, and cohort studies describing OS between 1955 and 2021 were identified. Individual manuscripts were reviewed for clinical features, presentation, and management. A total of 117 patient cases were gathered from 92 published articles. Common symptoms included hoarseness, dyspnea, cough, and dysphagia. The most common associated comorbidity was aortic aneurysm (41%), followed by pulmonary hypertension (35%), mitral stenosis (17%), and hypertension (12%). Among those who were managed via surgical intervention, 85.4% reported improvement in their hoarseness. While historically OS was associated with mitral stenosis, in recent decades, aortic aneurysms and dilation of the pulmonary artery from pulmonary hypertension have emerged as primary etiologies of OS. Therefore, OS should be considered in any patient presenting with hoarseness and history of cardiopulmonary disease. Surgical intervention in appropriate candidates resolves OS in most cases.

A Rare Case of a 54-year-old Male with Vocal Cord Paralysis Secondary to Left Atrial Enlargement

“…Previously, the primary cause was often attributed to an enlarged left atrium from conditions like mitral stenosis [ 1 ]. However, recent studies suggest that nerve palsy can be caused by compression between the dilated pulmonary artery and the aorta, such as in thoracic aortic aneurysms or pulmonary hypertension, which have emerged as the primary etiologies [ 2 - 3 ].…”

“…The syndrome's typical presentation consists of hoarseness, which may be accompanied by signs of heart failure, such as volume overload. These patients tend to experience a gradual development of hoarseness, which can progress to complete loss of voice depending on the severity of the injury to the left recurrent laryngeal nerve [ 3 ].…”

“…Various clinical conditions can cause recurrent laryngeal nerve palsy; some of these conditions are pulmonary hypertension, Eisenmenger's syndrome, mitral regurgitation, patent ductus arteriosus, left ventricular aneurysm, aortic pseudoaneurysms, aortic intramural hematomas, and mitral stenosis [ 3 ]. A prospective study by Loughran Et al.…”

“…reported the incidence of left RLN palsy due to OS to be 11% [ 4 ]. The most common etiology of OS is aortic aneurysms (41%), while OS due to left atrium enlargement makes up 27% of cases [ 3 ]. Diagnostic evaluations might involve transthoracic echocardiography (TTE), chest radiography, CT, MRI, and laryngoscopy to confirm left vocal cord paralysis [ 3 ].…”

“…The most common etiology of OS is aortic aneurysms (41%), while OS due to left atrium enlargement makes up 27% of cases [ 3 ]. Diagnostic evaluations might involve transthoracic echocardiography (TTE), chest radiography, CT, MRI, and laryngoscopy to confirm left vocal cord paralysis [ 3 ]. Treatment depends on the underlying cause and may include thoracic surgery, radiation therapy, endovascular aortic repair, or appropriate guideline-directed medical therapy (GDMT) for heart failure [ 3 ].…”