Case

A patient comes into your clinic with hoarse voice. Their blood pressure, temperature, cardiovascular responses, and respiration are normal. During your history, you learn that the patient recently had surgery to remove a thyroid tumor several weeks ago. A CT and MRI of the neck show no abnormalities.

Question 3/3 - What do you want to do for this patient?

Click on your selected option(s) below  (correct = 1,  possible = 3, over-thinking = 4+)

Incorrect. The patient has a horse voice, but no other respiratory difficulties. Cricothyrotomy is for establishing an emergency airway in the gap between the thyroid and cricoid cartilages in the situations that the upper airways are blocked. This would not be used for a horse voice.

Correct! If the nerve is inflamed by post surgery inflammation, then as that inflammation resolves nerve function would be restored. If the nerve was transected, it is very difficult to do anything to restore the fine level control that would be necessary for the vocal folds. Voice physical therapy would be the best long term for permanent dysfunction to train as much control as possible from the remaining nerve fibers.

Possible, but mixed sucess. While nerve grafts can be used to restore course function in large muscle groups, the precision of control for the vocal folds can result in mixed success with a graft or reinnervation procedure.

Incorrect. An infection can result in secondary inflammation that impairs nerve function, but this would be associated with temperature changes (either local around the infection or systemic through a fever). As the patient temperature is normal that argues against an infection in the neck.

Possibly. A neurology referral could help with explaining possible options should the dysfunction be long term. In the short term, a neurology referral probably isn't warranted until the deficit is determined to be long lasting.

Incorrect. A respirator is used for patients that experience difficulties breathing on their own. It would not be used for an ambulatory otherwise healthy patient with a horse voice.