Evaluation of Vocal Cord Paralysis Following Lung Transplantation

Objectives: Vocal fold paralysis or paresis (VCP) is a possible complication of lung transplant surgery. The otolaryngology service is often consulted to evaluate these patients via laryngoscopy and flexible endoscopic evaluation of swallowing (FEES). This study aims to quantify vocal fold pathologies via direct visualization. Methods: A retrospective chart review was conducted at a single quaternary medical center over a 3.5-year period, from December 2019 to May 2023. The presence of abnormal laryngoscopic findings in these patients was reviewed with specific descriptions of vocal fold findings reviewed and described in further detail. Results: A total of 78 patients met the inclusion criteria out of 127 lung transplants performed. Of these, 46 patients (59.0%) were found to have abnormal laryngoscopy findings on inpatient examination. Average time from the date of transplant to FEES examination was 10.3 days. Thirty-two patients (42.0%) were found to have pathologies at the site of the true vocal folds. Nine patients exhibited new VCP (11.5%), 13 with granuloma (16.7%), six with hemorrhage (7.69%), and four with polyp (5.13%). Only 13 patients (16.7%) followed up with laryngology once discharged. Conclusion: Vocal cord pathologies, including VCP, frequently occur in patients post-lung transplantation. It is vital for the transplant team and laryngologists to monitor and help institute appropriate care and follow-up for these patients. Level of Evidence: 2B.