Ortner's Syndrome Case Study

ORTNER'S SYNDROME - A RARE CAUSE OF UNILATERAL VOCAL CORD PARALYSIS

Abstract

Patient presented with hoarseness due to vocal cord paralysis secondary to cardiovascular pathology is an extremely rare entity, better known as cardiovocal syndrome or Ortner's syndrome. The common underlying pathology was described as an enlargement of the left atrium or recurrent laryngeal nerve compression by the pulmonary artery. We report a case of undiagnosed congenital heart disease in a young lady presented to the ear, nose and throat(ENT) clinic for hoarseness and the management of the patient. Even though hoarseness frequently encountered in the ear, nose and throat clinic, this is indeed a rare finding of hoarseness due to cardiovascular- related. Partial and complete resolution of the voice are reported in recent literature after treatment of the underlying cardiac pathology.

Keywords: vocal cord palsy, ortner's, congenital heart disease, cardiovocal

CASE PRESENTATION

Patient was not known to have any underlying medical problem. She also complained of reduced effort tolerance for the past two years. Left vocal cord palsy was visualized using fibre optic laryngoscopy(Figure 1a, Figure 1b). The rest of the otolaryngologic examination was normal. On auscultation, a loud systolic murmur at left sternal edge heard. No carotid bruit. A referral was made to the cardiologist and echocardiography showed pulmonary arterial and right ventricular dilation. Computed tomography (CT) of the neck and thorax showed enlarged pulmonary trunk and artery(Figure 2b). The patient was diagnosed with atrial septal defect(ASD). The patient underwent surgical heart repair of the defect and post-operatively was uneventful. Three months follow-up shows improvement of the voice and endoscopic examination showed a partial medialization of the left vocal cord(Figure