Laryngeal dyskinesia: An under‐recognized condition

Lawrence, Sean

doi:10.1111/j.1742-6723.2007.00912.x

Cited by 9 publications

(11 citation statements)

References 62 publications

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“…In the human medical literature, there are several synonyms for laryngeal dyskinesia (LD), including paradoxical vocal cord motion, vocal cord dysfunction or paradoxical vocal fold movement disorder (Lawrence 2007; Al‐Alwan and Kaminsky 2012; Matrka 2014). Common to all is the definition of a respiratory condition characterised by abnormal bilateral vocal cord adduction and airflow impairment at the level of the larynx without structural alterations (Lawrence 2007). Usually, the abnormal adduction movements in patients with LD occur during inspiration, causing stridor and acute respiratory distress as observed in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…Although LD is not directly linked to physical activity, it is observed in human athletes with an estimated prevalence of 2–3%, although it is considered an under‐recognised and underreported condition (Lawrence 2007; Al‐Alwan and Kaminsky 2012). Different factors such as the onset of physical activity, strong odours, psychological stress or locally irritating substances can trigger a LD episode (Lawrence 2007; Matrka 2014). In our patient, onset of physical activity frequently resulted in episodes of LD.…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis of LD is unclear. It is speculated that abnormal central neurological output leads to a phase reversal of arytenoid and vocal cord motion (Lawrence 2007).…”

Section: Discussionmentioning

confidence: 99%

“…However, other laryngeal disorders that appear in other species demonstrating dyskinesia of respiratory actions may also exist in horses. In man, laryngeal dyskinesia is defined as an upper respiratory condition in which abnormal vocal cord adduction is seen with airflow restriction in an otherwise healthy larynx (Lawrence 2007). The purpose of this case report is to describe a laryngeal dysfunction that has not been reported previously in equine literature.…”

Section: Introductionmentioning

confidence: 99%

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Laryngeal dyskinesia in a horse

Kühnle

Kümmerle

Parente

et al. 2019

Equine Veterinary Education

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Summary A 3‐year‐old Warmblood gelding was evaluated for intermittent respiratory distress and an inspiratory noise. These signs were mainly observed at exercise but sometimes occurred at rest as well. At the age of 2 months, a severe episode of respiratory distress had necessitated a temporary tracheotomy, which had then healed uneventfully. Examination of the patient and resting endoscopy revealed no structural laryngeal alterations. Exercise endoscopy revealed episodes of active bilateral laryngeal adduction during inspiration. Spirometrically, a corresponding impairment of inspiratory airflow was identified. These abnormalities were most pronounced at the trot but they occurred at magnitudes of inspiratory airflow lower than those inducing dynamic arytenoid collapse in horses with recurrent laryngeal neuropathy. Therefore, the diagnosis of a laryngeal dyskinesia characterised by an active bilateral arytenoid adduction during inspiration was made. No specific treatment was implemented. Three years later, the owner reported that the condition was markedly improved and the horse was used for pleasure riding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis of LD is unclear. It is speculated that abnormal central neurological output leads to a phase reversal of arytenoid and vocal cord motion (Lawrence 2007).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laryngeal dyskinesia in a horse

Kühnle

Kümmerle

Parente

et al. 2019

Equine Veterinary Education

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“…This disorder can lead to episodic dyspnoea, wheezing, stridor and apparent upper‐airway obstruction — symptoms that may be mistaken for anaphylaxis or asthma. Failure to recognise VCD has been associated with unnecessary treatments and hospitalisation 1 …”

mentioning

confidence: 99%

Sudden onset dyspnoea and recurrent stridor

Susanto

2018

Medical Journal of Australia

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A 37-year-old woman admitted for elective reduction mammoplasty developed stridor after extubation. During this episode, she reported difficulty with inhalation and globus sensation. Vital measurements were within normal limits, with resting oxygen saturation measured by pulse oximetry (SpO 2 ) of 99% on room air. There was no suggestion of difficult intubation in the anaesthetic report. Chest x-ray was unremarkable and full blood count revealed only mild neutrophilia. She was admitted to the high dependency unit for monitoring but required no additional support. Spirometry performed 24 hours later showed no airflow obstruction, although flowevolume curves revealed a flattened inspiratory loop. The stridor abated on its own over 48 hours.The patient had a history of chronic episodic stridor dating back to childhood. It was often precipitated by exposure to fumes, exertion, respiratory tract infection or emotional stress. She had received a variety of diagnoses, including asthma, laryngeal dystonia and anxiety-related stridor, and had been trialled on nebulised adrenaline, prednisolone therapy and intralaryngeal botulinum toxin injection, without significant improvement. There were also occasions when intubation had been considered on presentation.The patient had no features to suggest asthma. Previous computed tomography (CT) of the chest and neck, and neck ultrasound had been unremarkable. Repeat spirometry when she was asymptomatic was normal with no airflow obstruction, no bronchodilator reversibility and no flattening of the flowevolume curves (Box 1, A). Methacholine challenge test was negative.Bronchoscopy performed to exclude anatomical abnormality showed normal-looking vocal cords, no supra or subglottic stenosis and no tracheobronchomalacia; however, after the procedure, the patient developed abrupt onset of stridor with maintenance of oxygenation. The bronchoscope was re-introduced and paradoxical movement of the vocal cords was noted (Box 2). Repeat spirometry, performed while the patient was still symptomatic, revealed a variable flattening of the inspiratory curves (Box 1, B). A diagnosis of vocal cord dysfunction (VCD) was made. u 1 Spirometry with flowevolume curve, performed while the patient was asymptomatic, showing normal inspiratory and expiratory curves (A); and performed while the patient was clinically experiencing stridor showing flattening of the inspiratory curve (B) 2 Vocal cord adduction during inspiration visualised during the episode of stridor

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