Ortner Syndrome

What Is Ortner Syndrome?

Definition

Ortner Syndrome refers to hoarseness of voice caused by left recurrent laryngeal nerve palsy due to cardiovascular disease, most commonly enlargement of the left atrium.

Why It Matters

While hoarseness is commonly attributed to throat or lung issues, Ortner Syndrome reminds us to think outside the box—sometimes it’s the heart that’s whispering (or rather, silencing) your voice.

Causes of Ortner Syndrome

The key culprit is the left recurrent laryngeal nerve, which loops under the aortic arch and can be compressed by cardiovascular structures. Here are some of the major causes:

1. Mitral Valve Stenosis

• Most classic cause.

• Leads to left atrial enlargement, compressing the nerve.

2. Pulmonary Hypertension

• Causes dilation of the pulmonary artery.

• May impinge on the nerve pathway.

3. Aortic Aneurysm

• Expansion of the aorta can directly compress the nerve.

4. Congenital Heart Defects

• Such as Patent Ductus Arteriosus (PDA).

• Resulting in abnormal anatomy that puts pressure on the nerve.

5. Left Atrial Myxoma

• A rare benign tumor.

• Can enlarge the left atrium and mimic mitral stenosis.

Symptoms of Ortner Syndrome

The hallmark symptom is hoarseness, but there’s more:

1. Hoarseness of Voice

• Persistent, often without pain.

2. Voice Fatigue

• Voice tires easily, especially during prolonged speaking.

3. Weak or Breathy Voice

• Due to vocal cord paralysis on the left side.

4. Possible Cough or Dysphagia

• In severe cases, compression may also affect swallowing or cause a chronic cough.

Diagnosis of Ortner Syndrome

Clinical Evaluation

• History: Look for heart disease history.

• Physical Examination: Focus on cardiovascular and respiratory systems.

Laryngoscopy

• Reveals left vocal cord paralysis.

Imaging Studies

• Chest X-ray: May show cardiomegaly.

• CT/MRI of the chest: Evaluates cardiovascular structures compressing the nerve.

• Echocardiogram: Assesses heart function and structure.

Laryngeal Electromyography (EMG)

• Confirms nerve dysfunction.

Treatment of Ortner Syndrome

Treatment focuses on addressing the underlying cardiovascular issue and improving vocal function.

1. Treating the Cardiovascular Cause

• Surgery: Valve repair/replacement, aneurysm repair, or tumor removal.

• Medical Management: Pulmonary hypertension treatment, heart failure management.

2. Voice Therapy

• With a speech-language pathologist to maximize vocal potential.

3. Medialization Procedures

• Injections or implants to improve vocal cord closure if persistent hoarseness impacts quality of life.

Prognosis

• Prognosis depends on the cause and the timeliness of treatment.

• If the compression is relieved early, vocal cord function may return.

• Chronic compression may lead to permanent nerve damage.

FAQs about Ortner Syndrome

1. Is Ortner Syndrome common?

No, it’s quite rare. However, its association with serious heart conditions makes it clinically significant.

2. Can Ortner Syndrome be reversed?

If caught early and the underlying cause is treated, vocal cord function can improve. Delayed treatment may result in permanent changes.

3. Is hoarseness always due to Ortner Syndrome in heart disease?

No, hoarseness can have many causes, but persistent hoarseness in someone with cardiovascular disease should prompt evaluation.

4. How long does recovery take after treatment?

Recovery varies. Some patients see improvement within weeks after surgical intervention, while others may need months of therapy.

5. Can Ortner Syndrome be prevented?

Managing heart disease proactively can reduce the risk. Regular follow-ups and imaging help catch cardiovascular enlargements early.