Should Lyme disease be added to the causes of vocal cord paralysis?

sore throat, throat pain, vocal cord paralysis

Country singer Shania Twain will soon be back on tour after battling Lyme disease, which caused her to lose her voice for several years. The singer underwent two extensive operations to her throat in hopes of regaining her voice. She tells Prevention magazine, “I had to have an operation that was very intense and it’s an open-throat operation, very different from a vocal cord operation.” 

 

(Updated: 6/24/19)

In the Prevention article, doctors describe how Lyme disease can impact a person’s vocal cords. “Lyme can affect the nerves that are responsible for controlling the muscles in the vocal cords,” says Amesh A. Adalja, MD, an infectious disease specialist at Johns Hopkins Center for Health Security. “As a result, someone could technically lose their voice if they had Lyme disease.”

In fact, a case series published in the Journal of Voice identified Lyme disease as one of several causes of vocal cord paralysis, a condition that can dramatically impact patients’ lives, affecting voice, swallowing and airway function. [1] Identifying the cause is important, the authors state, in order to treat the condition successfully.

Vocal cord paralysis can be caused by neurologic and inflammatory conditions, as well as by various infections. “Infectious causes include Lyme disease, West Nile virus, varicella, herpes, Epstein-Barr, syphilis, and others.” [1]

The 2016 case series examined the records of 231 Pennsylvania patients with vocal cord paralysis (or paresis). The authors found that the prevalence of syphilis, myasthenia gravis, and Lyme disease was higher in these patients when compared with the national rate.

Join the conversation on Facebook: Shania Twain lost her ability to sing for several years due to Lyme disease.

Several of the patients with vocal cord paralysis had Lyme disease. “A positive Lyme titer with confirmatory Western blot was found in five patients (2.2%). When compared with the 2013 incidence of Lyme disease in Pennsylvania (0.039%), these results were statistically significant (P < 0.0001).” [1] Lyme disease is one of several infections that can cause a person to lose their voice (vocal cord paralysis). Click To Tweet

This is not the first time Lyme disease has been associated with vocal cord paralysis. In fact, it is possible that this is an underreported symptom, Adalja tells Prevention magazine.

Martínez-Balzano and colleague describe the case of a 90-year-old man who presented with dysphonia and upper and lower extremity weakness on his right side. [2] He also had bilateral vocal cord paralysis and respiratory failure which required a tracheostomy.

The man tested positive for Lyme disease. “The patient received IV ceftriaxone for 2 weeks, followed by complete recovery of motor and vocal function over 2 months.”

In 2010, Martzolff reported two cases of vocal fold paresis secondary to neuroborreliosis. “Both cases resulted in favorable outcomes after antibiotic treatment.” [3]

The authors point out the importance of testing vocal cord paralysis patients for Lyme disease, particularly in those living in endemic regions.

In 1988, a 45-year-old singer developed a sore throat and general malaise which progressed to hoarseness and left-sided neuralgia. The patient tested positive for Lyme disease and was treated with 3 weeks of doxycycline. “After 14 days of therapy she began to improve and after a few weeks she could speak and sing again,” writes Schroeter. [4]

“We have seen a case where serologically confirmed B. burgdorferi infection was associated with paralysis of the recurrent laryngeal nerve,” explains Schroeter.

“Because vocal fold paresis secondary to Lyme disease can be treated easily with antibiotics,” explains White, “testing patients with idiopathic vocal fold paresis should be routine, especially in endemic areas or in patients who have traveled to areas in which Lyme disease is endemic.” [1]

White and colleagues did not design their case series to test causality. “Although their causal relationship to vocal fold paralysis or paresis has not been investigated or established by this study, the medical importance of having established these diagnoses and instituted treatment is self-evident, and their possible causal association awaits further study.”

Nevertheless, the authors recommended implementing a comprehensive evaluation to identify serious and treatable causal or associated disorders underlying vocal fold paralysis and paresis.

The most common causes of this disorder include non-laryngeal malignancies, iatrogenic injuries, and idiopathic causes. Post-operative dysfunction after retraction, dissection along the recurrent laryngeal nerve and thoracic malignancy have also been identified as contributing triggers, explains White.

Additional causes of vocal cord paralysis include neurologic complications such as myasthenia gravis, severe degenerative spine disease, multiple sclerosis, amyotrophic lateral sclerosis, and Parkinson disease, as well as other disorders, White states.

Furthermore, inflammatory causes may include sarcoidosis, systemic lupus erythematosus, amyloidosis, and polyarteritis nodosa.

“Additionally, diabetes, thyroid disease, malnutrition, and vinca alkaloids have been found to cause vocal fold (cord) paralysis or paresis,” White explains.

“It is important for clinicians, especially tertiary and quaternary providers, to be familiar with the numerous diseases that may present in association with vocal fold paralysis or paresis,” states White, “and to consider comprehensive diagnostic evaluation to identify serious and treatable causal or associated disorders.”

References:
  1. White, M., et al., Laboratory Evaluation of Vocal Fold Paralysis and Paresis. J Voice, 2016.
  2. Martínez-Balzano, CD., Greenberg, B., Bilateral Vocal Cord Paralysis Requiring Tracheostomy Due to Neuroborreliosis. CHEST Journal, November 2014.
  3. Martzolff, L., et al., [Recurrent nerve palsy due to Lyme disease: report of two cases]. Rev Med Interne, 2010. 31(3): p. 229-31.
  4. Schroeter, V., G.G. Belz, and H. Blenk, Paralysis of recurrent laryngeal nerve in Lyme disease. Lancet, 1988. 2(8622): p. 1245.
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Deb
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Deb

My had a tick bite and passed away from bulbar ALS about 6 years later. She did not test positive, but the tests are notorious for false negative.

Julian
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Julian

I lost my voice completely 3 years ago. Not a good development for a musician. I have been having botox injections in my vocal cords for a year without success. I’m so glad I found this site. I was bitten by a tic 5-6 years ago and although I was treated with antibiotics at the time it would seem that there has been some lasting damage from the virus, mostly muscular.

Sharlene
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Sharlene

Glad I found this site as I was diagnosed with late Lyme in 2007 and after years of extensive treatment, still struggling with my vocal cords. Most recently worse sounding that usual. Also lip problems with them being sore since last summer. Also had a case of strep and reactivated mono last summer. Some old Lyme symptoms creeping back into my life most recently. I’m thinking it will never go away completely.

Colleen
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I’ve been searching for an overall review of my medical issues and found several with all the cysts in or on brain and other organs also with swollowing gag reflex issues. This will be added to my list of papers to take to my Drs. But Geisinger has also just denied one of my scripts which is for Lyme and many tests have been ignored with ” we don’t think insurance will cover” and they don’t even try to submit. Geisinger insurance too.
Suggestions?

Dr. Daniel Cameron
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The medical community is beginning to publish a wider range of papers covering new areas e.g. vocal cords. The issues are complex. Hopefully, other ENT specialists will look further.

Lori Geurin
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Interesting that they’ve found a tie between Lyme disease and issues with the vocal cords.

Ever since I’ve been infected with Lyme disease, my vocal quality has deteriorated at times. I used to love to sing, but lately have been frustrated with a scratchy voice which I’m sometimes unable to control like I could before Lyme.

I’ve read of other Lyme patients having chronic strep and throat pain but this hasn’t been my issue. It has been more about the vocal quality and control, which I’m assuming could be related to the vocal cords.

Dr. Daniel Cameron
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I also found the article helpful. You may want to contact the authors or share the blog with your ENT.

Shelly Scheyder
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Shelly Scheyder

Eight years ago I fell ill with bilateral vocal cord paralysis and all of the major symptoms of Lyme disease. I tested 4 bands positive. I had many diagnoses including Bulbar ALS. I am just this year getting treatment after 50 doctors including Mayo Clinic. Was told it was in my head. Thankful to finally be with an excellent LLMD. My vocal cords and one diaphragm are paralyzed.