Hu Amanda, Morrison Murray, Honey Christopher R
Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada.
Department of Surgery, Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada.
Ann Otol Rhinol Laryngol. 2020 Sep;129(9):849-855. doi: 10.1177/0003489420916207. Epub 2020 Apr 21.
Hemi-laryngopharyngeal spasm (HeLPS) has recently been described in the neurosurgical literature as a cause of intermittent laryngopharyngeal spasm and cough due to vascular compression of the vagus nerve at the cerebellopontine angle. We present the diagnostic criteria for this syndrome.
A retrospective chart review of six patients with HeLPS and three patients misdiagnosed with this condition are presented. All patients were diagnosed and treated at a tertiary care academic centre from July 2013 to July 2017.
Patients with HeLPS had five defining characteristics: 1) All patients had symptoms of episodic laryngopharyngeal spasm and coughing. Patients were asymptomatic between episodes and were refractory to speech therapy and reflux management. 2) Laryngoscopy showed hyperactive twitching of the ipsilateral vocal fold in two of the six patients. No other inter-episodic abnormalities were seen. 3) Botulinum toxin A injections into the thyroarytenoid muscle on the affected ipsilateral side reduced laryngopharyngeal spasms. Botulinum toxin injection in the contralateral thyroarytenoid muscle did not improve laryngopharyngeal spasm. 4) Magnetic resonance imaging revealed ipsilateral neurovascular compression of the vagus nerve rootlets by the posterior inferior cerebellar artery. 5) Microvascular decompression (MVD) surgery of the ipsilateral vagus nerve resolved all symptoms (follow-up 2-4 years).
The diagnostic criteria for hemi-laryngopharyngeal spasm (HeLPS) are proposed. Otolaryngology recognition of this new clinical entity may lead to a surgical cure and avoid the unnecessary therapies associated with misdiagnosis.
半喉咽痉挛（HeLPS）最近在神经外科文献中被描述为一种因小脑脑桥角处迷走神经血管受压导致间歇性喉咽痉挛和咳嗽的病因。我们提出了该综合征的诊断标准。
对6例HeLPS患者和3例被误诊为此病的患者进行回顾性病历分析。所有患者均于2013年7月至2017年7月在一家三级医疗学术中心接受诊断和治疗。
HeLPS患者有五个特征性表现：1）所有患者均有发作性喉咽痉挛和咳嗽症状。发作间期无症状，且对言语治疗和反流管理无效。2）喉镜检查显示6例患者中有2例患侧声带过度活跃抽搐。发作间期未见其他异常。3）向患侧甲杓肌注射A型肉毒杆菌毒素可减轻喉咽痉挛。向对侧甲杓肌注射肉毒杆菌毒素不能改善喉咽痉挛。4）磁共振成像显示小脑后下动脉对迷走神经根丝进行同侧神经血管压迫。5）同侧迷走神经微血管减压（MVD）手术可消除所有症状（随访2 - 4年）。
提出了半喉咽痉挛（HeLPS）的诊断标准。耳鼻喉科对这一新临床实体的认识可能会带来手术治愈，并避免与误诊相关的不必要治疗。
4级。
