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Airway compromise secondary to vagus nerve stimulator: case report and implications for otolaryngologists

Published online by Cambridge University Press:  02 October 2009

Y M Bhatt ,
P S Hans  and
A Belloso
Y M Bhatt*
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Royal Blackburn Hospital, Blackburn, UK
P S Hans
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Royal Blackburn Hospital, Blackburn, UK
A Belloso
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Royal Blackburn Hospital, Blackburn, UK
*
Address for correspondence: Mr Y M Bhatt, Department of Otorhinolaryngology Head and Neck Surgery, Royal Blackburn Hospital, Haslingden Road, Blackburn BB2 3HH, UK. Fax: 01254 736120 E-mail: bhatt_ym@yahoo.co.uk
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Abstract

Introduction:

Vagus nerve stimulators are devices used in the management of patients with drug-refractory epilepsy unsuitable for resective or disconnective surgery. Implanted usually by neurosurgeons, these devices are infrequently encountered by otolaryngologists. Despite significant anti-seizure efficacy, side effects related to laryngopharyngeal stimulation are not uncommon.

Case report:

A 28-year-old man with a history of effective vagus nerve stimulator use presented with a cluster of seizures and respiratory distress associated with intermittent stridor. The duration of stridor corresponded to the period of vagus nerve stimulation. Endoscopy revealed forced adduction of the left vocal fold against a medialised right vocal fold. The device was switched off and the stridor immediately resolved.

Conclusion:

Airway compromise is an under-recognised side effect of vagus nerve stimulation. We describe the first known case of stridor and contralateral vocal fold palsy in a vagus nerve stimulator user. We highlight the need for better understanding amongst otolaryngologists of the laryngopharyngeal side effects of this technology.

Keywords

Vagus Nerve StimulatorVocal CordsAirway ObstructionComplications, Epilepsy
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 5 , May 2010 , pp. 557 - 559
Copyright
Copyright © JLO (1984) Limited 2009

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