Vocal cord paralysis and superior laryngeal nerve dysfunction in Reye's syndrome.

Bilateral vocal cord paralysis and absent laryngeal sensation are previously unrecognized sequelae for Reye's syndrome, a severe acute encephalopathy in children. Four patients were seen at varying periods ranging from 2 weeks to 5 years after their diagnosis of an episode of severe Reye's syndrome over a 20-year period at the Children's Hospital of Los Angeles (Calif). All of the patients had bilateral true vocal cord paralysis with absent laryngeal sensitivity that was documented at endoscopy. As many as 50% of survivors of severe Reye's syndrome have breathy voices or aphonia. It is suggested that some of these children may have vocal cord dysfunction that is not the result of intubation, and are at risk for aspiration and its dangerous sequelae. A vagal nuclear injury is theorized to explain the sensory motor dysfunction of the larynx in these children.