Vocal Cord Dysfunction
From Anvita Health Wiki
Contents |
Etiology
- paradoxical closure of the vocal cords during respirations
- contributing factors
- physiologic response to underlying asthma
- reflex to protect airway in patient with chronic sinusitis & purulent postnasal drip
- severe esophageal reflux into larynx
- response to inhaled airway irritants
- psychiatric disorder - conversion disorder
Clinical-manifestations
- wheezing
- shortness of breath
- predominantly throat tightness
- hoarseness or difficult phonation during symptomatic episodes
- laryngeal stridor
- symptoms are often worse during inspiration
- predominance of daytime symptoms; absence of night time awakenings
- onset may be abrupt
- may be exacerbations & remissions
Laboratory
-
- abnormal flow-volume loop
- limitations in inspiration consistent with extra- thoracic obstruction
- normal A-a gradient despite profound respiratory distress
- laryngoscopy while patient is experiencing symptoms
- paradoxical approximation of the anterior 2/3 of the vocal cords & a small posterior opening
Management
- failure of response to to high-dose glucocorticoids
- acute episodes respond to helium- oxygen mixture (70% helium, 30% oxygen)
- long term management
- reassurance
- withdrawal of unneeded asthma medications
- speech therapy
- treatment of underlying contributing factors
More General Terms
Additional Terms
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 15
