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Developing Vocal Cord Paralysis!

Aviatrix36440Aviatrix36440 Posts: 5,740
Greetings all! About 3 weeks ago I posted that I was starting to lose my voice - I am almost 6 months post op from a C6/7 ACDF with a partial Corpectomy. Like many, I had the squeaky voice for about 2 and a half weeks after surgery, then it seemed all done. No pain, no problems swallowing, talking, all was good in that area!

At just past the 5 month post op, I started losing my voice in 5-10 minute increments. No soreness, scratchy, nothing, just the voice got weird. High pitch would go, some words were "skippy" in how they came out. Then after a few minutes back to normal. At first this was only a few times a day, so I didn't think much of it then. By week 2, I was getting it near 10 times a day, and would last 30-45 minutes. I started to get puzzled because there was no pain, I didn't just finish yelling or anything like that. My husband even started noticing me losing my voice more frequently. I chuckled to ease his concerns, and told him the "good" thing is there isn't any throat pain.

This week it all changed! The voice issues aren't going away and are steady! I can't sing even the most basic song (not saying I was a singer to begin with mind you!), when I talk it sounds like I have laryngitis but with a big difference. When *I* have a cold that causes laryngitis, and I lower my voice to a whisper, you can't tell I have any problems, with this however, if I try to whisper, I have even worse problems speaking! The left side of my neck also feels weird - again no pain. Drinking liquids. 4 out of ten times I drink something, I end up chocking! I didn't have that before either.

Today we had a Professor of Neurosurgery from upper state NY at our location to speak with our officers about his success concerning an officer who was shot several times, locations to include the spinal area and back of the head. Excellent briefing! He then went on to discuss various conditions of spine problems that arise in this job...boy did I have a lot of eyes on me! During a break I asked him if I could ask him an "off the record" question concerning my voice. As I asked him that, he was looking at my throat. He asked me when my surgery was, and was my voice like this since the surgery. I advised him that I had the usual horse throat voice for about 2 weeks after surgery, then all was fine until about 3 weeks ago. He told me that he could "hear" by my voice patterns that I was exhibiting strong symptoms of vocal cord paralysis! He then advised me that for us "post surgical" types this far from the surgery, *most* times it is caused by the hardware moving and irritating the Recurrent Larygneal Nerve! This floored me, but in some ways, didn't surprise me?!? He of course followed that up properly that he can't give me a diagnosis without scans and a full work up. He advised I might want to see about getting a "Sagital CT Scan" (not sure of the spelling) so my doctor can see the soft tissues to be sure since an MRI and hardware don't make for clear enough viewing of the area. I asked him why if the hardware might be moving I had no pain. He basically said that all depends on how fast it moves, and what it hits! This has only taken 3 weeks to develop, so I was not a happy camper after this conversation!

My brain is screaming, "What next? This is ridiculous! I can't believe yet again, something else to deal with!" Did I mention nerves suck? Okay Brenda, breath, in out, in out..... Thanks all for taking the time to read this. Aside from getting this "out there" for my own psycho health, hopefully if someone else has something like this, it will be of help, or heads up? Take care, and again, thanks for listening!!!

Brenda
PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
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13

Comments

  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    That's just terrible Brenda. I hope you can get the scan really soon to find out the problem. I can only imagine how scary it is. Have you had a chance to call your doctor yet? I'm glad that the professor was there today or you may have put off going to see about it. Please let me know how you are doing.

    Debbie
  • Howdy Debbie,

    Thanks very much for your reply. :-) I am a bit bummed this go around! I normally stay upbeat, but it just hit me wrong. I actually went outside to the back of the hanger and let the 'water works' go! I think I needed that. :---) Being at work, I was in uniform, and tears and the badge only go good at funerals! (G) I put together a one page e-mail that I am going to send shortly. In the morning I will call his office staff (who are pretty good too), and let them know it is there, and to please get it to my Dr. Hopefully he will get with me tomorrow, or early the next day. He has been very good about getting back with me when I have concerns. I am his favorite "problem child" after all!

    I think you are right Debbie, I don't know if I would have brought this forward yet either if I hadn't talked with this NS/Professor. I looked him up, and he has an excellent track record and history as a surgeon of the spine.

    I'm beginning to think "if it isn't one thing it's another" anymore! I am still holding off with imaging the Thoracic and Lumbar - I don't think I want to know *all* the details right now! *HUG* Thanks again Debbie.

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
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  • i just hope the surgeon can solve this problem for you quickly. it must be so stressfull having this voice problem.

    joan
  • joanxyxy said:
    i just hope the surgeon can solve this problem for you quickly. it must be so stressfull having this voice problem.

    joan
    Thanks very much Joan,

    It gets frustrating when things "stack on", and I feel this is a stack on! I sent an e-mail to my NS, and I will call tomorrow to let the staff know it is there. I am hoping he will give me answers, or let me know what tests he wants. I want my voice back! (G) Thanks again for your support. *HUG*

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Hi,
    This is my first post, although I have been reading the posts on this forum for about a month.

    I have right sided vocal cord paralysis as a result of ACDF C6-7 done four months ago. I have been through the mill with appointments and tests--I also developed esophageal dysmotility and spasms, with difficulty swallowing from the surgery.

    I am glad that you have an email in to your NS and that you are also going to follow up right away with a phone call. I would also suggest that you make an appointment with an ENT as soon as possible. The NS will likely send you to one (in addition to the tests he'll order to image your fusion/ instrumentation placement), but my recommendation is to go ahead and get an appointment with an ENT now.

    The ENT will do a laryngoscope (not painful, but may make you gag--they do numb your throat with lidocaine) so that they can see the specifics, such as which cord is affected, whether it's a partial or complete paralysis, whether or not the cord is lying in the middle or to the side (I am guessing to the side based on your choking of liquid symptoms), and whether or not atrophy of the cord and associated muscles has occurred. These specifics are important for both you and your doctors to know.

    I truly feel for you and empathize with you, as vocal cord paralysis has a huge impact on our lives, both physically and emotionally. It's exhausting to talk (from air wasting & the effort it takes), and sometimes we are at increased risk for aspirational pneumonia. There are so many aspects to this unwelcomed complication.

    I hope the NS gets you in ASAP. Again, please make an ENT appointment ASAP as well. I will send positive thoughts your way.
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  • Howdy Reenie!! :-)

    Thanks ever so much for your most excellent and informative reply!!!! *HUG*

    Mine is on the left side - same side of both of my fusion surgery sites. I had X-Rays almost 4 weeks ago and I looked them over again today. For what I was able to research on the location of the Larygneal nerve and the cords, I was shocked! For some reason I thought they were a little further away from the spine than they are! My "wing" they used on the last fusion (almost 6 months now) is tilted left, but I don't see how it could come to where it is causing this. A tiny bit of history with this fusion.

    It is my second one in just over a year. The first one fused quickly, and I feel that was 100% on fixing the issues from that level. This one (C6/7) was good for about 6 weeks, maybe 7, then I had a loud "knuckle cracking like" noise (my hubby heard it 6 feet away!!), and then most of my pre-surgical issues came back and then some! An MRI clearly showed the top of the fusion was separated and ragged. The X-Ray - you can clearly see the space between the bone and the graph (top), bottom looks great.

    Now with all that stated, I wonder if there is now movement at that location, and that is what is causing this? Sorry, just thinking out loud as they say! :-) I am just frustrated that things keep compounding for no real reason. I behaved, followed all directions, and did not over due. Grrrr...

    My NS was in emergency surgery all day, so he didn't get back with me. It was kind of funny in that when I called the office, initially my voice was "gone" and she says, "Excuse me, I can't hear you. Can you say your name again and what you need?" My voice sort of came back (but certain words "like who) "skip" or barely comes out! I then told her, "As you can hear, or umm..not hear, I am losing my voice for some reason! I sent Dr. xx an e-mail, and I would appreciate if you print it and get him to read it?" She told me that she had already brought it up, and printed it. I didn't know he was in surgery till later. ENT - excellent idea! I will look around and see who is around my area. I don't need a referral to go to a specialist, so that takes some of the pain out of it!!

    Reenie, here are some of my questions. And again, even what you have posted so far is doing wonders for my understanding of this latest, seeeettttback!

    1. Is your paralysis due to the hardware?

    2. If it is the hardware, did they tell you what options you have? I am guessing if the hardware is doing it, they have to go in and fix it? Grrr...

    3. How fast did you go from intermittent voice to pretty much all the time horse, squeaky, etc.?

    4. Can you sing?

    5. When you talk, do you have certain words that just don't come out? Me, "who, happened, middle of America, too, where" for example - only the back part of the word comes out! Gets worse as the day goes on.

    6. If yours is hardware, who does the surgery if that is the end fix? NS with the ENT doc?

    7. How far can this progress? I know life can be very bad if they both do it, but the NS yesterday was pretty sure it was only the left. Scans and laryngoscope will of course clear that up! :-) It just seems like this puppy went downhill pretty fast!

    I am sure I have more questions, but right now the Lyrica (grin) is blocking them! You are sooooo right about the personal affects of this! At work if I squeak or can't get a word out, they either laugh (and I laugh with them so they don't know I am really freaked out!!), or I get "Are you getting a cold?" One more person asks me that I will scream. Oops, yelling isn't happening anymore either!

    Again *HUG* Thanks sooo much for your post and input!! Sorry for all the questions, but this is so new to me, and looks like you have a very good grasp on this whole mess. Thanks again!! Oh, and welcome to posting and leaving the lurking mode!!

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thank you for your nice welcome to the boards. I have been wanting to post numerous times, but it just seems I don't ever know where to begin! There are so very few of us with vocal cord paralysis (from here out I'll use "VCP") due to ACDF complications, and when I saw your post I really wanted to connect. I also want to make sure that you move quickly on this....certainly not to scare you, but the reality is that the sooner the problem is fixed and the pressure is taken off of the laryngeal nerve, the more likely the chance that the nerve can heal (so that the paralysis is temporary rather than permanent).

    My situation is a bit different than yours, in that my VCP was a direct result of surgical trauma rather than a hardware issue developing later. It's kind of a long story, which I will certainly share soon (probably a different thread, cuz it will be long and I don't want to overtake your thread!). My ENT is pretty certain that my laryngeal nerve was traumatized due to the retraction during surgery. The fact that I also have esophageal issues since surgery, makes his theory pretty likely. I am a petite female, and the retraction was probably more aggressive than my nerves/trachea/esophagus, etc could handle.

    I'll try to answer some of your questions, if I can. :)

    1. Is your paralysis due to the hardware? No, see above.

    2. If it is the hardware, did they tell you what options you have? I am guessing if the hardware is doing it, they have to go in and fix it? Grrr...
    I am also guessing that they will need to go in and remove the hardware to take the pressure off of the nerve.

    3. How fast did you go from intermittent voice to pretty much all the time horse, squeaky, etc.?
    I was "hoarse" initially as expected. My voice continued to get worse, squeaky, breathy, and stayed that way (I do get compensation intermittently). The reason it seemed to get "worse" is that the cord was initially frozen in the center, therefore allowing the other cord to touch it. I still sounded bad then too. The paralyzed cord and the muscles used for movement then atrophied within a matter of a couple of weeks, which made my cord pretty much fall to the side and stay there.

    4. Can you sing? Nope. :( I sometimes try when I am alone.

    5. When you talk, do you have certain words that just don't come out? Me, "who, happened, middle of America, too, where" for example - only the back part of the word comes out! Gets worse as the day goes on.
    Yes. Some days it is certain words/sounds, and other days they are all bad. It definitely worsens as the day goes on. The occasional snippets of good words are usually due to compensation (the good cord and muscles taking over). Eventually, the good cord and muscles get too tired/overworked, and that's why it gets worse at the end of the day or when we've used our voices a lot.

    6. If yours is hardware, who does the surgery if that is the end fix? NS with the ENT doc?
    The NS would do this. Ideally they should have an ENT and/or a neuro-monitoring group present to monitor nerve function during the surgery.

    7. How far can this progress? I know life can be very bad if they both do it, but the NS yesterday was pretty sure it was only the left. Scans and laryngoscope will of course clear that up! It just seems like this puppy went downhill pretty fast!
    This is why it's important to see an ENT asap, so they can see the extent of progression. If the paralysis is incomplete or partial, the chances of recovery improve dramatically. If it's complete/total, there's still a chance of recovery of the nerve and the vocal cord, but they need to get the pressure off of the nerve soon. What I mean by incomplete versus complete is if both the adductor and abductor muscles are affected (the muscles that bring the cords together and apart). It's all very complicated. Believe me, I knew none of this before it happened to me. My ENT taught me a lot, and I have been researching like crazy.

    You're right, VCP of both cords is very bad and life-threatening. VCP of one cord is bad and life-altering though not usually life-threatening. You probably do just have the one cord affected like the NS said. If it was both, you would have a lot of difficulty breathing.

    My VCP is on the right, but it is "complete", meaning both adductor and abductor muscles aren't getting the nerve impulse. I am told that there is a chance that the nerve can still heal. They don't do anything permanent to the vocal cord until one year post op, in the hope that it heals in the interim. I have had one injection of collagen into the paralyzed cord (it is a temporary measure)to bulk it up to help with the voice, but unfortunately it didn't work. I am scheduled for the second try next week.

    I'm crossing my fingers for you and sending positive thoughts.

    Hang in there! I'm so glad that you are being pro-active. : ) I hope your NS gets back to you very soon and that an ENT can get you in very soon as well.

    Reenie

  • Welcome back Reenie. :-)

    Before I posted my original post concerning VCP, I dug around the site, but mainly found (as thankfully is normal) people with voice, swallowing issues for a few weeks up to 2 months after surgery, but none with later development!

    I feel fortunate to have someone to "connect with" that is going through this. I am sorry that you are going through this, and even more bummed that it was directly due to your surgery. I am 5'3", and when I had the C6/7 surgery, I weighed 115lbs, so small here too. Thanks to Lyrica (heh), gained a bit. (G) Ironically, my NS prefers the left side of the neck because he feels there is less risk to the Larygneal nerve! From what I have found on the Internet, there really isn't that much difference!

    I look forward to reading the details of your whole ordeal when you post it! It is weird that there isn't more information posted in the forums about it. Maybe that is a good thing? I like everyone signed the surgical release knowing that cord damage along with the nerve is possible. I was never told or advised this "issue" could come up way after surgery. :-( Before I got that quick consult, I basically chocked it up to "scar tissue", but this NS said, "No, it is too long after your surgery for scar tissue to suddenly be an issue. Plus it wouldn't happen so fast if indeed it was possible for scar tissue to do this." Sounded logical to me. He's been a Professor and NS for 30 years, so I guess his initial assessments might not be too far off? (G)

    If they find indeed the hardware is doing it, I have a feeling this could be an "interesting" surgery as the top of the fusion isn't taking. So I guess he can do a revision while he's there! I am guessing too from your post, and too what I read on the net, they probably won't try the injections if the cord or nerve is being compressed by the hardware? My logic is telling me that would expose it for far more damage as it is designed to bulk = bad if being squeezed already? Sigh

    Singing... I like to sing to Janis Joplin, Carpenters, ABBA - but I can't even complete the words when sung (Mama Mia, Here I go again, Mama...) "I go again" comes out! Hehehe...sorry, trying to get a bit of humor at myself. I have one better than trying to sing alone. I blare the radio in my car so I don't hear my crappy new sort of voice!! This way I can take a mental break and "think" I am singing normally!

    Atrophied in 2 weeks!!!! That is scary right there Reenie...geesh! I am bringing my 2010 network book with me to work tomorrow so I can look and see what I have here in South Florida, and too look them up on the net to see what I can find about their background, training, experience, etc. Hopefully get an appointment too. My NS normally doesn't do surgery on Fridays, so hopefully in the morning I will hear from him. I figure by then too, I will have an appointment with him, helps with making an appointment with the ENT. If for some odd reason my NS doesn't think there is anything bad going on, I will run not walk, run to the ENT! I doubt he is going to blow this off as he's pretty darn good at his job and how he's treated me so far.

    You mention that yours might be permanent. Compensation from the other nerve. Will that damage the "good" side over time? I hope too for you they can figure something out to get you fixed or as close to normal as possible. Are they looking at possible surgery, maybe to move the cord and nerve to a more roomy environment in your neck?

    I'm gonna do a bit more digging on the ole world wide to get more education in the old gray matter! I did the same sort of thing with my spine, this way the doctor isn't talking "Greek" to me!

    The question I couldn't remember earlier! You said yours was on the right. Did you, or do you now have vertical numbness from just above the collar bone to the base of your chin on that side? That too started for me when my voice started acting up. Hopefully tomorrow I will have 1 or 2 appointments set up!

    Thanks so much for the positive energy! I will send some your way as well! *HUG*

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Reenie,

    I too think an NS would do this if the hardware has to come out. Since the fusion (top) didn't fuse, the NS would be who *I* would want to do that. If it is hardware, that surgery is going to be a busy one! Thanks again Reenie. :-)

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Hi Brenda,
    When I read your post, I checked the area between my collarbone and chin on the affected side, and yep, it's numb. I had noticed that a few months ago, but figured it was still due to the surgical scar, so I kind of dismissed it at the time.

    We don't know if my VCP is permanent or temporary. It's a "wait and see" approach, which is hard. Like you said, most people get function back in a few weeks to a few months, so the more time that goes by isn't in my favor statistics-wise. However, I still try to remain hopeful.

    They won't do anything permanent (like moving the cord over or putting an implant in the vocal cord) until one year has passed since the ACDF.

    Sometimes I wish I could snap my fingers and make the rest of the year zoom by. I am crossing my fingers that the collagen injection next week works this time.

    Please let me know when you hear back from the NS, and also if you get an ENT appointment scheduled. I'll be thinking about you and sending positive thoughts your way.

    Reenie
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