biology

Ortner's syndrome

Ortner's syndrome is a biology topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Ortner's syndrome rather than just read about it. In short: Ortner's syndrome is a rare cardiovocal syndrome and involves recurrent laryngeal nerve palsy from cardiovascular disease. It was first described by Norbert Ortner (1865–1935), an Austrian physician, in 1897.

Key takeaways

Ortner's syndrome belongs to biology; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Ortner's syndrome to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Ortner's syndrome from memory before moving on to harder problems.

Reference excerpt

Ortner's syndrome is a rare cardiovocal syndrome and involves recurrent laryngeal nerve palsy from cardiovascular disease. It was first described by Norbert Ortner (1865–1935), an Austrian physician, in 1897. Dysphagia caused by a similar mechanism is referred to as dysphagia aortica (also called dysphagia megalatriensis), or, in the case of subclavian artery aberrancy, as dysphagia lusoria. Due to compression of the recurrent laryngeal nerve, it can cause the hoarseness of the voice, which can also be a sign of mitral stenosis. A second Ortner's syndrome, Ortner's syndrome II, refers to abdominal angina.

Causes Due to its low frequency of occurrence, more common causes of hoarseness should be considered when suspecting left recurrent laryngeal nerve palsy (LRLN). When considering cardiovocal syndrome, the most common historical cause is a dilated left atrium due to mitral stenosis, but other causes, including pulmonary hypertension, thoracic aortic aneurysms, an enlarged pulmonary artery and aberrant subclavian artery syndrome have been reported compressing the nerve.

Some examples of reported cardiovascular causes include:

Congenital abnormalities: Atrial septal defect Aortopulmonary window Ebstein's Anomaly Patent Ductus Arteriosus (PDA) Surgical intervention: Transcatheter closure of a PDA Incidence: due to the close proximity of the LRLN to the aortic arch, transient paralysis can occur in 10% of cases while permanent effects can occur in 1% of cases. This can further be attributed to using metal clips (used to control bleeding) during the surgical procedure and is more common in premature infants. Cardiac disease: Left atrial enlargement due to valvular heart disease Notable case: A middle-aged male had ongoing cough, hoarseness of voice, and shortness of breath for two years without a history of smoking was found to have mitral valve stenosis due to calcification. This led to left atrial enlargement, elevated pulmonary artery pressure, pulmonary artery hypertension, and right ventricular enlargement. This cardiomegaly, or enlargement of the heart, led to compression of the LRLN. Atrial Myxoma Aorta: Traumatic injury Incidence: Although injury to the thoracic aorta is often fatal, in 10% of cases that take longer to present, hoarseness may be the first symptom. Aortic dissection More commonly affects the right recurrent laryngeal nerve as the most common type of aortic dissection is type A (Figure 2). Pseudoaneurysm Notable case: A male with long-standing uncontrolled hypertension and hoarseness of voice attributed to life-long smoking was found to have a pseudoaneurysm of the aortic arch which was compressing the LRLN. Pulmonary disease: Pathophysiology: Due to vascular congestion in the lung, the pulmonary artery (Figure 3) becomes dilated and can compress the aorta and the LRLN. Primary pulmonary hypertension Pulmonary emboli Malignancy (pulmonary, mediastinal) Autoimmune: Mixed connective tissue disease Notable case: A young female with a history of mixed connective tissue disease presented with hoarseness of voice and was found to have secondary pulmonary artery hypertension. This was causing right heart enlargement and therefore compression of the LRLN. Idiopathic

Diagnosis It is important to consider a potential cardiovascular cause of hoarseness particularly in patients with progressive disease. Once suspected, performing a laryngoscopy is the first step in identifying damage to the left recurrent laryngeal nerve. Examination includes:

Swallowing evaluation to assess for risk of aspiration (food going down the trachea instead of the esophagus). Breathing testing to rule out incomplete vocal cord closure. Voice quality.

History This correlation between hoarseness of voice and cardiac anatomic pathology was first described by Dr. Norbert Ortner in 1897 after he observed left recurrent laryngeal nerve palsy (LRLN) in three patients with left atrial enlargement secondary to mitral valve stenosis. The definition of Ortner's syndrome has since then expanded to encompass all possible causes of left recurrent laryngeal nerve palsy with cardiac etiologies.

References

Illustrations

Worked examples

Example 1 — a first encounter with Ortner's syndrome

Start with the simplest possible case. Write down what Ortner's syndrome claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In biology, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Ortner's syndrome before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Ortner's syndrome ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Ortner's syndrome

In research: Ortner's syndrome appears in biology research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Ortner's syndrome in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Ortner's syndrome is common in secondary-school and first-year university syllabi. It links to neighbouring topics Cardiovascular diseases, Neurological disorders, Syndromes affecting the heart, so understanding it makes those chapters shorter.
In everyday life: Look for Ortner's syndrome outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Ortner's syndrome in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Ortner's syndrome means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Ortner's syndrome out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Ortner's syndrome in simple terms?

Why does Ortner's syndrome matter?

Because it connects several biology ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Ortner's syndrome?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Ortner's syndrome.