Sarcoidosis as a Cause of Left Recurrent Laryngeal Nerve Palsy

Abstract

Vocal cord paralysis is an unusual complication of sarcoidosis. Sarcoidosis may affect vocal cord function by either direct involvement of the cord or by involvement of the neural pathways, including the nucleus ambiguous, the 10th cranial nerves, and the superior and recurrent laryngeal nerves. There have been only two previous case reports of sarcoidosis with mediastinal adenopathy causing compression of the left recurrent laryngeal nerve and vocal cord paralysis. We present a third such case.

Sarcoidosis Presenting as Hoarseness and Dysphagia

“…It has been postulated that recurrent laryngeal nerve compression from enlarged mediastinal lymph nodes may also be a factor. Aorto‐pulmonary lymphadenopathy has been documented in 75% of the patients in one study 9 . If this were the case, predominantly left‐sided vocal cord paralysis would be a common finding.…”

Sarcoidosis Presenting as Bilateral Vocal Cord Paralysis From Bilateral Compression of the Recurrent Laryngeal Nerves From Thoracic Adenopathy

“…5,8 In each of the six cases of unilateral vocal cord paralysis discussed previously, only the left cord was affected. A similar predilection for left-sided nerve involvement has been described for the more common causes of recurrent laryngeal nerve injury, and is likely because of the longer intrathoracic course of the left nerve as passes around the arch of the aorta.…”

“…Oral corticosteroids were used to treat four of the patients with unilateral cord paralysis, three of whom experienced return of vocal cord function. 4,5,6,8 The fourth patient, reported by Jaffe et al, suffered persistent unilateral cord paralysis despite 8 months of corticosteroid therapy. 4 In addition to compressive lymphadenopathy, sarcoidosis may result in polyneuritis affecting various cranial nerves.…”

Diagnostic Testing for Vocal Fold Paralysis: Survey of Practice and Evidence‐Based Medicine Review

“…Although there are some reports, mostly several decades old, which mentioned the practice of testing for syphilis in the evaluation of vocal fold paralysis, 1,12,24 this was not reported as a significant diagnostic step by any paper. Measurement of the ACE level as a diagnostic test for sarcoidosis, however, was noted by a series of case reports associating this disease with vocal fold paralysis 25,27,31,32,36 . In all five cases, however, the patients also had hilar lymphadenopathy on CXR.…”

“…Measurement of the ACE level as a diagnostic test for sarcoidosis, however, was noted by a series of case reports associating this disease with vocal fold paralysis. 25,27,31,32,36 In all five cases, however, the patients also had hilar lymphadenopathy on CXR. Three of four patients for which an ACE level was reported had elevated levels.…”