Vocal Cord Dysfunction Arising From Vagal Nerve Stimulator Removal

To The Editor: In 2005, vagal nerve stimulation received approval for treatment of adult patients with refractory major depressive disorder. Adverse effects associated with vagal nerve stimulation implantation are cough, hoarseness, and dysesthesias of the throat related to electrical stimulation, along with rare cases of localized deep-tissue infection (1 – 3) . Seldom is removal of the device required, although it is recommended in cases of infection refractory to treatment (such as aspiration and antibiotics) or potential systemic infection (4) . We report the unique case of a patient requiring vagal nerve stimulator removal, which resulted in vocal cord hoarseness.

Although deep-tissue infection arising after vagal nerve stimulator implantation is uncommon, there can be considerable morbidity in instances in which infection occurs (1, 4) . The literature to date suggests that these problems are generally encountered within 1 month postimplantation (4) .

The present case is the first, to our knowledge, in which meningitis in an adult patient prompted vagal nerve stimulation hardware removal and, most notably, scar tissue excision and hardware removal precipitated a permanent left recurrent laryngeal nerve injury. The most appropriate and efficacious approaches to treating deep-tissue infection and meningitis arising after implantation is limited in the available literature. Because of hazards encountered in the excision of scar tissue associated with explantation, treatment with intravenous antibiotics while retaining the wire coil in situ may be the most prudent first-line approach to the management of complications (1) . Refractory, persistent infection, despite conservative treatment, might necessitate eventual device removal. Patients considering vagal nerve stimulation treatment will need to be made aware of the risks of infection and potential complications if explantation is ever required.