Service d'ORL et de chirurgie cervico-faciale, Hôpital Henri-Mondor-A Chenevier et Hôpital intercommunal, AP-HP, Créteil, 94010, France; Faculté de Médecine, Université Paris-Est, Créteil, 94010, France; Inserm, U955, E13, Créteil, 94010, France; CNRS ERL7000, Créteil, 94010, France.
Service d'ORL et de chirurgie cervico-faciale, Hôpital Henri-Mondor-A Chenevier et Hôpital intercommunal, AP-HP, Créteil, 94010, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Oct;136(5):373-377. doi: 10.1016/j.anorl.2019.05.019. Epub 2019 Jun 6.
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).
The objective of this study was to determine in patients with unilateral RLN palsy if dyspnea could be associated with HVS.
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.
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.
In summary, this study is a proof of concept that HVS might be involved in dyspnea associated with unilateral RLN palsy.
单侧喉返神经（RLN）麻痹可导致声音嘶哑和吞咽困难。单侧 RLN 麻痹对呼吸困难的作用尚未完全阐明。我们的假设是，空气泄漏可能是导致过度通气综合征（HVS）的原因。
本研究旨在确定单侧 RLN 麻痹患者的呼吸困难是否与 HVS 相关。
在 12 个月的时间内，对所有因甲状腺切除术而出现永久性单侧 RLN 麻痹并伴有不明原因呼吸困难的患者进行了测试。进行了尼姆斯评分、过度通气测试、动脉血气、肺功能和心脏测试。如果至少有两个标准存在，则诊断为 HVS：尼姆斯评分>23；在过度通气测试期间至少有 2 种常见症状再现；呼气末二氧化碳压力（EpCO2）<30mmHg 或在 3 分钟自愿过度通气后 5 分钟恢复期结束时 EpCO2 初始值的<90%。
366 例因良性疾病行甲状腺切除术的患者中，有 10 例出现永久性单侧 RLN 麻痹和呼吸困难。在纳入的 10 例患者中，8 例在过度通气测试中被诊断为 HVS，无心脏/肺部功能障碍。
总之，这项研究证明了 HVS 可能与单侧 RLN 麻痹相关的呼吸困难有关。
