Voice Lost Due to Nerve Damage? - 1250276

Wed, 11/14/2012 - 20:59

Had ULL lobectomy and a wedge resection on LLL September 24, 2012. Had respiratory failure after surgery. Was kept in coma for 11 days. Was intubated 4 times during the 11 days. Upon release was sent to rehab center. Have been there since October 9. Have been receiving occupational, physical & speech therapy. Still very weak. Can't walk more than 50-60 feet with a walker before becoming weak and short of breath. Voice is usually no more than a whisper. Was sent to an ENT. Was told left vocal cord was paralysed. Dr. said a nerve running from the left vocal cord to chest was damaged during the lobectomy. Was also told my voice would probably not improve much more than what it is. I thought there might be a little damage from being intubated 4 times. That would not surprise me. This did surprise me. Was unaware nerve damage was even a possibility. My first question concerns the weakness and being SOB. At this stage is that to be expected considering all that had taken place during the surgery? Also is it really a possibility a nerve could have been damaged during the surgery resulting in a paralysed vocal cord? Would appreciate any insight you can give regarding these issues.

Thank You.

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Dr West

Yes, unfortunately it's absolutely possible that lung surgery can damage the phrenic nerve, which leads to hoarseness and diminished voice. It also leads to loss of the function of the diaphragm on that side of the chest, which can contribute to more shortness of breath, since the diaphragm helps to compress and expand the lung on that side during the breathing cycle.

-Dr. West

certain spring

2bbcontinued, I am so sorry to hear about your traumatic experience of surgery, and about the after-effects you are dealing with now. I hope the various therapies will get you back on your feet.
Speaking as a fellow-patient, I would want to check the consent form to see if nerve damage was specified as a possible risk.
It probably isn't any consolation to say this, but it seems amazing that you are still alive after respiratory failure and being in a coma. Best wishes for your recovery.

letswatch

I know this is later but I had the same thing and was told left vocal cord was paralysed. The lymph nodes had a tumor pressing on the nerve and it is always the left vocal cord that is paralysed.

My ong sent me to his best ent who does surgery and injected/have to find procedure name and that it would take 4 days to work and for a month I might sound like a teenage kid and then normal. The next day my voice was loud enough to hear after 5 weeks of not being able to talk but it became infected and my radiation doctor thought maybe the radiation I just had done to my neck (had a face mask to strap my head to table so I would not move) might have caused the pain but found out it was the nerve in the lymph nodes pressing on it so the surgery. The infection caused pain when I swallow and when I eat and when I drink but the problem was I had been losing weight and this made it easier to lose more weight because it hurt to swallow. Taking antibioitic liquid for 10 days and also there is a crack in the tongue so pills could get stuck so I had stop taking pills. My pain pills were small so i crushed them and drank them with milk to get it down but because I have lower bough obsruction which can be caused by pain medication and not walking alot I have lot so much weight that my normal walks were not possible so I have to endure pain to avoid having my stomach pumped which happened the day after my cancer was biospied because I had pain so severe I could not sleep so I took pain meds regularly and was not able to walk much so I spent 5 days in the hospital not eating because the pump does not allow it so that is why I am not taking much pain meds plus I lost so much weight I do not eat enough calories per day to walk more.

Applied for palliative care and nurse said to stop metemucul and use miralax. I have and have not obstructed but not drinking enough water and pain pills can obstruct so drink sips and when it does not hurt drink more water and do the best I can.

carrigallen

It is not unusual for lung tumors or some lung surgeries to injure the nerve that goes to the voicebox, especially on the left side. This is because the left recurrent laryngeal nerve goes all the way down to the middle of the left lung, before going back up to your voicebox. Any disruption or interruption along its course can cause temporary or longer-lasting problems with function of the vocal cord. Sometimes cancer will adhere to the nerve, so the surgeon may have no way of knowing it is involved before removing the cancer.

It is also possible for a vocal cord to be injured after multiple attempts at intubation, or prolonged intubation itself, since this procedure involves trying to push a plastic tube between the vocal cords. Since intubation is a life-saving procedure, we usually consider the benefit greater than the potential risk.

It may advisable to see an ENT who specializes specifically in vocal procedures. For single-side paralysis, an injection (injection laryngoplasty) or cord implant (medialization thyroplasty) can usually improve the voice and reduce cough. Hope this helps.

pami229

I also have nerve damage occurring from a left upper lobectomy which has caused left vocal cord paralyzation and loss of voice. This occurred in March 2013 at which point I was told it could take up to a year to see if my voice comes back. I had one injection into the vocal cord which produced a small voice for about a month and a half. The second attempt at injection was a disaster with the scope tube making me cough and the dr unable to find the right injection site. After her 4 attempts I stopped the procedure.

What I've been told is that if my voice does not come back the "fix" is to place a spacer to push the vocal cord towards the center of the trachea. For me there are concerns about this, particularly the narrowed area and increased chances of aspiration. I have be unable to find someone who has had this procedure that I may talk to about it.

Question for the doctor - are there other solutions available?

THanks.

catdander

Pami229, I'm very sorry to know you've lost your voice in this way. I don't know of anyone of our regularly responding members to have had this problem. Perhaps someone in the shadows, who reads the forums will have some input. It appears from Dr. Creelan's post that an ENT would be the specialist who has the best input here and unfortunately we don't have an ENT on faculty. Perhaps Dr. Weiss, a head and neck cancer specialist will have some input. I will ask him to comment if he has something to add, he may need a day to respond, he was busy with Yom Kippur and has had added family things to keep him especially busy this weekend.

My 2 cents, my layperson, stranger, too much info giving 2 cents; any invasive procedure has inherent dangers and those dangers should be weighed against the benefits. The damaged nerves may heal in their own slow time. As your doctor suggested it could take a year to know. Give your body the time it needs to heal. My husband has had a hell of a time healing from his thoracotomy 4 years and 3 weeks ago. He's still feeling some improvement in his chest.

I hope this is resolved and you're talking out loud soon.

Janine
forum moderator

Dr West

Yes, this is a situation in which we would consider referring a patient to an ENT specialist, since they can often do a minor procedure to compensate for that vocal cord dysfunction. I've had several pateints recover good vocal function after this straightforward process, which typically involves injecting a gel into the vocal cord.

-Dr. West

pami229

I have seen an otolaryngologist. Is that different than an ENT?

I was hoping to find out if there are other options besides inserting the spacer to push the vocal cord into the middle.