Viral neuropathy of the vagus or recurrent laryngeal nerve is believed to be a common cause of chronic cough, hoarseness, and/or laryngospasm, much as facial nerve palsy is attributed to viral illness. Patients report a flu-like illness, usually with severe coughing and
FIGURE 4 Resorption of laryngeal and tracheal cartilage, with granulation tissue over tracheotomy tract.
FIGURE 5 Acute laryngeal paralysis with herpetic vesicles in laryngeal and pharyngeal mucosa.
hoarseness, and examination may show unilateral laryngeal weakness or paralysis. In most cases, coughing and spasm resolve within six months, but the vocal fold weakness persists. There is little medical evidence for viral infection as a common cause of laryngeal paralysis; however, there are anecdotal reports of elevations of varicella-zoster immunoglobulin G levels in association with acute laryngeal paralysis. Mucosal lesions consistent with a herpetic infection have been noted in a patient with acute onset of laryngeal paralysis (Fig. 5) (12).
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