From the Guidelines
Vagal nerve injury symptoms include hoarseness or voice changes, difficulty swallowing (dysphagia), abnormal gag reflex, reduced stomach acid production, slow heart rate (bradycardia), and digestive issues like bloating or delayed gastric emptying, as reported in the most recent study 1. The symptoms vary depending on which branch of the vagus nerve is damaged, as this nerve controls functions in the throat, heart, lungs, and digestive system.
- Unilateral injury (affecting one side) typically causes milder symptoms than bilateral damage.
- Diagnosis usually involves a physical examination, laryngoscopy to assess vocal cord function, and sometimes specialized tests like barium swallow studies or gastric emptying scans.
- Treatment depends on the cause and severity, ranging from watchful waiting for mild cases that may resolve spontaneously to surgical repair for severe injuries, as suggested by 1 and 1.
- Voice therapy may help with vocal cord dysfunction, while dietary modifications and medications like prokinetics can address digestive symptoms. The vagus nerve (cranial nerve X) is particularly vulnerable during neck surgeries, especially thyroidectomies, which is why these symptoms should be carefully monitored after such procedures, as highlighted in 1 and 1. The most effective diagnostic approach involves imaging the full extent of the vagus nerve from the skull base to the mid chest, using contrast-enhanced CT or MRI, as recommended by 1 and 1.
From the Research
Vagal Nerve Injury Symptoms
- Delayed gastric emptying or gastroparesis can occur as a result of thoracic and foregut operations that cause vagal nerve injury 2
- Vagal nerve injury can lead to gastrointestinal symptoms, and vagal nerve integrity testing may help define who has vagal nerve dysfunction 2
- Vagal nerve stimulation has been shown to improve intestinal blood flow after trauma and hemorrhagic shock, and may have a protective effect against gut injury 3
- Vagal nerve stimulation may also have anti-inflammatory effects, reduce oxidative stress and apoptosis, and improve endothelial and mitochondrial function, leading to reduced tissue damage 4
Related Conditions
- Traumatic nerve injury can lead to affective pain, which may be alleviated by gabapentin 5
- The vagus nerve plays a role in inflammation, mood, and pain regulation, and vagus nerve stimulation may modulate these processes 6
- Vagal nerve stimulation may exert a neuromodulatory effect to activate certain innate "protective" pathways for restoring health 6
Diagnostic and Therapeutic Considerations
- Vagal nerve integrity testing may be used to evaluate patients with prior thoracic or gastric surgery who are at risk of vagal nerve injury 2
- Vagal nerve stimulation may be a potential therapeutic approach for reducing tissue-specific ischemic reperfusion injury 4
- Gabapentin may be used to alleviate affective pain after traumatic nerve injury 5