Dear Dr. Dankle,
My father has suffered with peripheral neuropathy since the Fall of 95. As a
result of medication (steroids) and a weakened system, he developed Ramsey
Hunt in April of 96. The resulting symptoms have been paralysis of the left
side of his face and left vocal cord, loss of sight and hearing on the left
side, and extreme dizziness. While in the hospital he had an opertion to
shift the vocal cord over so that he could speak. He also has a feeding tube
which is connected directly into his stomach for feeding because food goes
into his lungs if he tries to eat orally. It has been 9 months since the
paralysis first occurred. Is there any hope that the nerves in his throat
could regenerate so that he could eat and if not, what alternatives
exist(traditional or alternative) so that he could eat?
Can anything be done about the dizziness?
Thank You
Reply: -----------------------
Apparently, your father has suffered a paralysis of cranial nerves 2, 7, 8, and 10 based upon your description of symptoms. The 10th cranial nerve (vagus) innervates the vocal cord muscles and also provides sensation to the lining of the vocal cord structures. The vocal cords are most obviously involved in the production of voice. However, another very important function of the vocal cords is to act as a barrier against the entry of food or water into the lungs during swallowing. When the vocal cords are paralyzed because of an injury or disease affecting the vagus nerve, there is potential for significant voice and swallowing dysfunction. In some cases the problem can be severe enough to result in aspiration pneumonias which can occasionally be life-threatening.
There are a number of medical interventions that are available to improve both the voice and swallowing dysfunction that results from vagus n. paralysis. Perhaps the best treatment currently available is known as a thyroplasty which is a surgical procedure typically done under local anesthesia where an implant is positioned in the larynx to essentially move the paralyzed vocal cord closer to the normal vocal cord. This procedure can restore the voice to near normal quality in many cases and can contribute to significantly improved swallowing function. However, the surgical procedure by itself is not likely to be enough to result in swallowing improvement in most patients with this problem. Almost all will require expert swallowing rehabilitation from a speech therapist as part of the overall treatment plan. It sounds as though your father has had some type of medialization to his vocal cord. Swallowing therapy with a speech therapist would be advisable if it has not already been prescribed. As to the issue of recovery, the prognosis is probably poor if it has been 9 months since the onset of paralysis, however recovery can theoretically occur in some cases of nerve injury (providing the nerve has not been cut as in trauma or surgery) as long as 12 months after the onset of paralysis.
In regards to dizziness, most likely this is related to both vision loss (cranial nerve 2) and hearing loss (cranial nerve 8). True vertigo likely would result from injury to the 8th cranial nerve, however, over a period of time one would expect significant adaptation whereby the balance system would accomodate to the injury and the vertigo would gradually recover. In the case of the 8th cranial nerve palsy of this nature, if recovery has not occured in a few months the prognosis is poor. If dizziness, especially true vertigo, persists beyond a few months then I would recommend a specialized form of physical therapy known as vestibular habituation therapy which is designed to encourage adaptation in the part of the nervous system responsible for spatial orientation.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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