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Clinical Pulmonary Medicine:
Obstructive Airways Disease: PDF Only

Vocal Cord Dysfunction

Jamilla, Francis M.D.; Stevens, Damien M.D; Szidon, Peter M.D.

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Abstract

: Vocal cord dysfunction (VCD) is symptomatic paradoxical inspiratory vocal cord adduction in the absence of organic disease. The pathogenesis of VCD remains speculative, and the interaction of structural, physiologic, and behavioral factors has not been elucidated. Most of these patients are young women who are often misdiagnosed as having asthma. A high index of suspicion is required to make the diagnosis, which is best established by laryngoscopy during a symptomatic episode. The pathognomonic finding is the observation of, during an episode of acute dyspnea, full apposition of the anterior two thirds of the vocal cords, leaving a small posterior opening, the "posterior chink." Diagnosis of VCD during an asymptomatic period is difficult. VCD should be considered in all atypical or "difficult" patients with asthma. Spirometry may be normal, and the contour of the flowvolume loop may reveal the pattern of variable upper airways obstruction. Laryngoscopy during asymptomatic periods is often normal. Provocative techniques, said to be able to precipitate attacks of VCD in asymptomatic patients, have not been adequately described. Failure to recognize VCD can result in potentially dangerous interventions: intubation, tracheostomy, and in inappropriate management of asthma, such as the excessive use of long-term, systemic corticosteroid therapy. The initial management of VCD includes reassurance, sedation, continuous positive airway pressure, and inhalation of helium-oxygen mixtures. Long-term management is multidisciplinary and highly individualized. It combines speech therapy, relaxation techniques, and stress management. However, the efficacy of therapy has not been formally tested. The prognosis is variable, ranging from complete resolution to a progressive course that is unresponsive to therapy, which requires a long-term tracheostomy in some patients.

Clin Pulm Med 2000;7(3):111-119

(C) 2000 Lippincott Williams & Wilkins, Inc.

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