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Anesthesia

Problems swallowing/talking after surgery

01/20/2004

Question:

Over a period of 10 yrs., I`ve had 3 long cervical and 1 long lumbar spinal fusion. My voice has changed; sounds rasping when I`m tired; I have problems swallowing; learned to Heimlich myself when food gets stuck, and even have sudden muscle spasms trying to swallow saliva and think I`m going to choke to death. One surgeon said all the tubes put in during surgery could affect vocal chords, muscles, and nerves. What advice or help is there to relieve these problems? Does any of this also cause me to slur my words when I`m tired? I`d truly appreciate your insight. Many thanks.

Answer:

I`m sorry to hear of your difficulties. Recent studies are showing that endotracheal intubation – that is, the insertion of a plastic breathing tube into the windpipe – can cause minor damage to the vocal cords in a surprisingly high number of patients. This can occur even when the intubation is performed by an expert and appears to go absolutely smoothly.

When the larynx (voice box) is examined with special instruments after apparently routine intubation, bruising or swelling of the vocal cord structures is often seen. This minor damage causes hoarseness which, fortunately, almost always improves over a few days.

Unfortunately, endotracheal intubation is necessary for most surgeries on the spine, and we have not yet discovered ways to protect our patients from these minor injuries. More severe or permanent damage to the larynx (voice box) from endotracheal intubation is quite rare.

Risk factors may include rheumatoid arthritis and the use of steroid medications. It is not clear whether damage to the voice box increases with the duration of the surgical procedure, but in someone who has had several long procedures, the chances of injury are probably higher.

The symptoms other than hoarseness that you mention – problems swallowing, food obstruction, muscle spasms and slurred speech, do not sound like they are connected to the tubes you’ve had placed during surgery. They raise the possibility of a neurologic (nerve) problem, or a throat disorder, that might possibly be related to your previous surgical procedures but may also have nothing at all to do with them. I would strongly advise that you seek a specialist referral to an appropriate professional, such as an ear, nose and throat doctor or a neurologist.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University