Unilateral recurrent laryngeal nerve palsy post-thyroidectomy: Looking for hyperventilation syndrome - 07/06/19

Doi : 10.1016/j.anorl.2019.05.019

E. Bequignon ^a,^b,^c,^d,^{^{1
first co-author, equally contributed to this manuscript.},}^⁎ , H. Dang ^a,^{^{1
first co-author, equally contributed to this manuscript.}}, F. Zerah-Lancner ^b,^c,^d,^e, A. Coste ^a,^b,^c,^d, L. Boyer ^b,^e,^f,^g, J.-F. Papon ^c,^d,^f,^g,^h
^a Service d’ORL et de chirurgie cervico-faciale, Hôpital Henri-Mondor–A Chenevier et Hôpital intercommunal, AP–HP, Créteil, 94010, France
^b Faculté de Médecine, Université Paris-Est, Créteil, 94010, France
^c Inserm, U955, E13, Créteil, 94010, France
^d CNRS ERL7000, Créteil, 94010, France
^e Service de physiologie et d’explorations fonctionnelles, Hôpital Henri-Mondor–A Chenevier, AP–HP, Créteil, 94010, France
^f Inserm, U955, E4, Créteil, 94010, France
^g Service d’ORL et de chirurgie cervico-faciale, Hôpital Kremlin-Bicetre, AP–HP, Le Kremlin-Bicetre, 94275, France
^h Faculté de Médecine, Université Paris-Sud, Kremlin-Bicêtre 94070, France

^⁎Corresponding author at: Service d’ORL et de chirurgie cervico-faciale, Hôpital Henri-Mondor–A Chenevier et Hôpital intercommunal, AP–HP, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil.Service d’ORL et de chirurgie cervico-faciale, Hôpital Henri-Mondor–A Chenevier et Hôpital intercommunal, AP–HP51, Avenue du Maréchal de Lattre de TassignyCréteil94010

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Abstract

Aims

Unilateral Recurrent Laryngeal Nerve (RLN) palsy is responsible for dysphonia and difficulties in swallowing. The role of unilateral RLN palsy on dyspnea is not fully elucidated. Our hypothesis is that air leak could be responsible for development of hyperventilation syndrome (HVS).

Objective

The objective of this study was to determine in patients with unilateral RLN palsy if dyspnea could be associated with HVS.

Material and methods

Over a 12-month period, all patients with permanent unilateral RLN palsy after thyroidectomy complaining from the onset of unexplained dyspnea were tested. Measurement of Nijmegen score, an hyperventilation test, an arterial blood gas, lung function and cardiac tests were performed. The diagnosis of HVS was defined if at least two criteria were present among: Nijmegen score>23; reproduction of at least 2 usual symptoms during hyperventilation test; an expirated pressure of CO2 (EpCO2)<30mmHg or<90% of the initial EpCO2 after a 5minutes recovery period following a 3minutes voluntary hyperventilation.

Results

Ten out of 366 patients with thyroidectomy for benign disease had permanent unilateral RLN palsy and dyspnea. Among 10 patients included, 8 were diagnosed having HVS on the hyperventilation test without cardiac/lung dysfunction.