Posterior glottic stenosis from an endotracheal tube intubation
Approximately 70-year-old male who had heart surgery 8 months ago. His endotracheal tube was removed the day after surgery, but needed to be replaced because of difficulty breathing. It remained in for another 2 days. When it was removed, he had lost his voice. His voice was weak for several months and then was a high pitch for several months. He had a significant amount of coughing. His pitch gradually lowered at about the same time that his breathing began to become difficult, about 3 months after surgery. He began to wheeze. He was given steroid inhalers in case this was asthma. He now has noisy breathing with any type of activity and his cough sounds like the bark of a dog.
This is a very typical story for an injury to the lining of the larynx from an endotracheal tube. When the tube remains in for several days, the lining at the back of the larynx may ulcerate. After the endotracheal tube is removed, the edema keeps the vocal cords open and so the voice is poor. Over about 3 months, the vocal cords are pulled together by the scar tissue. The voice improves but the breathing deteriorates since the vocal cords cannot open very widely.
His vocal cords are about 2 to 3 mm apart during breathing. If he breathes in very rapidly, the vocal cords suck together from Bernoulli effect.