Bilateral Vocal Cord Palsy Secondary to Rheumatoid Arthritis: A Case Report

Abstract Introduction Rheumatoid arthritis (RA) affects the larynx in 13-75% of cases and is usually subclinical. Airway obstruction due to vocal cord fixation occurs late in RA and presents as an inspiratory stridor. Case presentation An 85-year-old woman presented to A&E Resus with tachypnoea, stridor and drowsiness. An ABG showed hypercapnic respiratory failure. A flexible nasendoscopy was performed which revealed adducted vocal cords with paradoxical breathing. The patient had been admitted with a similar presentation before which was attributed to her longstanding RA. Potential surgical options including tracheostomy, vocal cord lateralisation and vocal cord/arytenoid removal were considered but ultimately, these options were deemed unsuitable for the patient. Conclusions Stridor is a late but life-threatening complication of RA that has viable surgical options of tracheostomy and vocal cord lateralisation; however, the appropriateness of such procedures should always be correlated with the patient’s clinical status and background.