Tapia’s Syndrome Secondary to Prolonged Intubation and Tracheostomy in a Patient With Opioid Dependence With Spontaneous Recovery

Tapia syndrome is known as a rare complication characterized by neurologic deficits involving the hypoglossal nerve (XII) and recurrent laryngeal branch of the vagal nerve (X). It can occur after airway manipulation, including intubation. Typical signs and symptoms include dysphagia and dysphonia. This case report describes a case of Tapia syndrome post-intubation in a critical care unit. He is a 46-year-old male with a background of opioid dependence who presented with a reduced level of consciousness and type 1 respiratory failure (T1RF). He had multiple intubations during his hospital stay and prolonged mechanical ventilation requiring a tracheostomy. He developed ventilator-associated pneumonia and <i>C. difficile</i> infection. After decannulation, he developed persistent dysphonia, dysphagia, tongue deviation, and aspiration. He had a nasendoscopy, which revealed a paralyzed right vocal cord in the paramedian position and tongue deviation, which is consistent with Tapia's syndrome. Initially, he was considered for injection laryngoplasty, but he showed significant spontaneous improvement as his left vocal cord was compensating very well. Despite being recorded before in the literature, our case is important to recognize Tapia's syndrome post-intubation and the challenges of managing airway complications in patients after opioid dependence. It also highlights the potential for spontaneous recovery with conservative management in Tapia's syndrome, as this spontaneous recovery is not well-documented in the literature, and most of the cases require steroids, vitamin B complex, or even more invasive interventions to improve the condition.