Recurrent Laryngeal Nerve Palsy in Sarcoidosis Diagnosis and Management

Objectives: Vocal cord palsy secondary to sarcoidosis is a rare manifestation and it is very unusual for the patient to present with it as a chief complaint. This is the first literature review conducted highlighting the importance of this condition. 46 years lady presented with hoarseness of voice without any significant history related to upper airway or lung condition. Suffers only from obesity. Naso-endoscopic examinations showed left vocal cord palsy. CT scan of chest confirmed hilar lymphadenopathy which was diagnosed as sarcoidosis with endobronchial ultrasound (EBUS) guided lymph node biopsy. Symptoms were related to neuro-sarcoidosis and peripheral recurrent laryngeal nerve neuritis. No local compressive sings noted on imaging. The patient was treated with local vocal cord injection and steroids were not suggested considering the patient’s obesity.

Methods: The literature review revealed only twenty-three reported cases. Number of cases included were 16 in relation to the nerve pathway. Cranial cases were excluded. One case report was due to peripheral neuro-sarcoidosis.

Results: The common practice was to manage with oral steroids, however, only few cases used injection laryngoplasty as treatment. Injection laryngoplasty is actively practiced in the UK under the National Institute of health and care Excellence (NICE) guidelines [ IPG130] which was published on the 22nd of June 2005.

Conclusion: Knowledge about vocal fold paralysis in sarcoidosis needs highlighting and should be considered by clinicians in cases that may initially appear to be idiopathic in nature without any chest complains related.

Keywords: Sarcoidosis; Recurrent laryngeal nerve; Paralysis; Palsy; Vocal cord injection; Mononeuritis multiplex; Dysphonia; Hoarseness of voice