Unilateral associated laryngeal paralysis due to varicella-zoster virus: virus antibody testing and videofluoroscopic findings

Abstract

The relationship between varicella-zoster virus and idiopathic associated laryngeal paralysis was examined in five patients, using complement fixation or enzyme immunoassay testing. In all cases, significant changes in serum levels of varicella-zoster virus antibody were observed. Videofluoroscopy was useful in assessing the severity of the dysphagia and in making an accurate diagnosis; both laryngeal elevation and weakness of pharyngeal wall contraction were also observed. In two cases in which antiviral therapy was delayed, the outcome was poor, with increased levels of varicella-zoster virus immunoglobulin M found on enzyme immunoassay. The outcome of the condition may thus depend both on the speed of antiviral therapy commencement following onset of symptoms, and on the levels of varicella-zoster virus immunoglobulin M antibody (measured by enzyme immunoassay). Our study suggests that varicella-zoster virus should be considered in the differential diagnosis of patients with idiopathic associated laryngeal paralysis, and rapid antiviral therapy should be initiated when necessary.

Varicella Zoster Virus Infection of the Pharynx and Larynx without Vocal Cord Palsy

“…A significant elevation in VZV antibody titers is observed in some of the patients diagnosed as idiopathic associated laryngeal paralysis [3]. It is not rare for samples to be negative for VZV reactivation at the first examination, and significant changes (greater than 2-fold) in IgG antibody values in paired sera are considered to indicate a recent VZV infection [7].…”

“…The value of early antiviral treatment may be similar in patients with associated laryngeal paralysis caused by VZV reactivation [3]. If unilateral eruption in the pharyngolaryngeal mucosa is observed in patients with associated laryngeal paralysis, the possibility of VZV reactivation should be considered.…”

“…Recently, it has been speculated that a proportion of idiopathic associated laryngeal paralysis are due to VZV [3]. Most cases might be misdiagnosed as idiopathic laryngeal paralysis due to lack of appropriate serological tests.…”

A rare case of herpes zoster maxillaris with cranial polyneuropathy

“…Herpes zoster infection of the larynx accompanied by RHS with cranial polyneuropathy is extremely rare, with only few reported cases in the literature. 1,[6][7][8][9] About 12% of all peripheral facial nerve palsies are caused by varicella zoster virus. The occurrence rate of associated cranial polyneuropathy has been reported to be 1.8-3.2% and cranial nerves VII, VIII, IX and X are the ones most commonly affected.…”

A case of herpes zoster oticus with multiple cranial nerve palsy

“…Herpes zoster infection of the larynx accompanied by RHS with cranial polyneuropathy is extremely rare, with only few reported cases in the literature. [1][2][3][4][5] About 12% of all peripheral facial nerve palsies are caused by varicella zoster virus. The occurrence rate of associated cranial polyneuropathy has been reported to be 1.8-3.2% and cranial nerves VII, VIII, IX and X are the ones most commonly affected.…”