Hostname: page-component-6766d58669-h8lrw Total loading time: 0 Render date: 2026-05-21T06:18:44.059Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Information

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1Handforth, A, DeGiorgio, CM, Schlachter, SC, Uthman, BM, Naritoku, DK, Tecoma, ES et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology 1998;51:48–55CrossRefGoogle ScholarPubMed
2Marrosu, F, Serra, A, Maleci, A, Puligheddu, M, Biggio, G, Piga, M. Correlation between GABA (A) receptor density and vagus nerve stimulation in individuals with drug-resistant partial epilepsy. Epilepsy Res 2003;55:59–70CrossRefGoogle ScholarPubMed
3The Vagus Nerve Stimulation Study Group. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 1995;45:224–30CrossRefGoogle Scholar
4Zumsteg, D, Jenny, D, Wieser, HG. Vocal cord adduction during vagus nerve stimulation for treatment of epilepsy. Neurology 2000;54:1388–9CrossRefGoogle ScholarPubMed
5Kersing, W, Dejonckere, PH, van der Aa, HE, Buschman, HP. Laryngeal and vocal changes during vagus nerve stimulation in epileptic patients. J Voice 2002;16:251–7CrossRefGoogle ScholarPubMed
6Ghanem, T, Early, SV. Vagal nerve stimulator implantation: an otolaryngologist's perspective. Otolaryngol Head Neck Surg 2006;135:46–51CrossRefGoogle ScholarPubMed
7The National Society for Epilepsy. http://www.epilepsynse.org.uk [20 January 2009]Google Scholar
8Charous, SJ, Kempster, G, Manders, E, Ristanovic, R. The effect of vagal nerve stimulation on voice. Laryngoscope 2001;111:2028–31CrossRefGoogle ScholarPubMed
9Ben-Menachem, E. Vagus nerve stimulation, side effects, and long-term safety. J Clin Neurophysiol 2001;18:415–18CrossRefGoogle ScholarPubMed
10Schallert, G, Foster, J, Lindquist, N, Murphy, JV. Chronic stimulation of the left vagal nerve in children: effect on swallowing. Epilepsia 1998;39:1113–14CrossRefGoogle ScholarPubMed
11Kirse, DJ, Werle, AH, Murphy, JV, Eyen, TP, Bruegger, DE, Hornig, GW et al. Vagus nerve stimulator implantation in children. Arch Otolaryngol Head Neck Surg 2002;128:1263–8CrossRefGoogle ScholarPubMed
12Milby, AH, Halpern, CH, Baltuch, GH. Vagus nerve stimulation for epilepsy and depression. Neurotherapeutics 2008;5:75–85CrossRefGoogle ScholarPubMed
13Lungdren, J, Ekberg, O, Olsson, R. Aspiration: a potential complication to vagus nerve stimulation. Epilepsia 1998;39:998–1000Google Scholar
14Lundy, DS, Casiano, RR, Landy, HJ. Effects of vagal nerve stimulation on laryngeal function. J Voice 1993;7:359–64CrossRefGoogle ScholarPubMed
15Bernards, CM. An unusual cause of airway obstruction during general anesthesia with a laryngeal mask airway. Anesthesiology 2004;100:1017–18CrossRefGoogle ScholarPubMed
16Hatton, KW, McLarney, JT, Pittman, T, Fahy, BG. Vagal nerve stimulation: overview and implications for anesthesiologists. Anesth Analg 2006;103:1241–9CrossRefGoogle ScholarPubMed
17Malow, BA, Edwards, J, Marzec, M, Sagher, O, Fromes, G. Effects of vagus nerve stimulation on respiration during sleep: a pilot study. Neurology 2000;55:1450–4CrossRefGoogle ScholarPubMed
18Marzec, M, Edwards, J, Sagher, O, Fromes, G, Malow, BA. Effects of vagus nerve stimulation on sleep-related breathing in epilepsy patients. Epilepsia 2003;44:930–5CrossRefGoogle ScholarPubMed
19Malow, BA, Levy, K, Maturen, K, Bowes, R. Obstructive sleep apnea is common in medically refractory epilepsy patients. Neurology 2000;55:1002–7CrossRefGoogle ScholarPubMed
20McGregor, A, Wheless, J, Baumgartner, J, Bettis, D. Right-sided vagus nerve stimulation as a treatment for refractory epilepsy in humans. Epilepsia 2005;46:91–6CrossRefGoogle ScholarPubMed
21National Institute for Health and Clinical Excellence. http://guidance.nice.org.uk/CG20 [20 January 2009]Google Scholar