Munchausen's stridor: non‐organic laryngeal obstruction

Patterson, Roy; Schätz, Michael; Horton, Mark B.

doi:10.1111/j.1365-2222.1974.tb01390.x

Cited by 201 publications

(102 citation statements)

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“…The first modern case report was published by PATTERSON et al [3] in 1974 who demonstrated laryngoscopic evidence of VCD, which he termed ''Munchausen's stridor''. In 1983 CHRISTOPHER et al [4] published a seminal paper that described a group of patients evaluated for severe asthma who were found to have VCD.…”

Section: Historical Perspectivementioning

confidence: 99%

Vocal cord dysfunction: what do we know?

Kenn

Balkissoon²

2010

Eur Respir J

145

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Vocal cord dysfunction (VCD) is a disorder caused by episodic unintentional paradoxical adduction of the vocal cords, which may induce acute severe dyspnoea attacks not responsive to conventional asthma therapy. The aetiology of VCD is complex and often multifactorial. The essential pathophysiology is that of a hyperfunctional laryngeal reflex to protect the lower airway as a result of any combination of post-nasal drip, gastro-oesophageal reflux, laryngopharyngeal reflux and/or psychological conditions. Laryngoscopic demonstration of the paradoxical motion while wheezing or stridorous is considered the diagnostic gold standard. Speech therapy, including the use of special relaxed-throat breathing patterns is effective for VCD that is purely of the functional nature. Knowledge of the clinical features of VCD and identifying factors that may be contributing to the development of VCD can provide adequate clues to the correct diagnosis and management.

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Section: Historical Perspectivementioning

confidence: 99%

Vocal cord dysfunction: what do we know?

Kenn

Balkissoon²

2010

Eur Respir J

145

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“…The earliest portrayals of VCD were based mainly on case reports and small series. Earlier belief considered VCD as a psychological illness, a factitious entity, a hysterical neurosis or a somatoform disorder with "a loss of or alteration in physical functioning" [8,[31][32][33][34]. Supposedly, unnamed stressors or an unidentified disturbance in both patient and family play significant roles in VCD pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Vocal Cord Dysfunction after an Inhalation Exposure

Brooks¹

2017

J Allergy Ther

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The manuscript embodies case material and the author's extensive personal experience to address a perceived or actual airborne exposure when incorrectly judged as due to intrathoracic/lung damage when in reality the outcome is the more innocuous extrathoracic/upper airway's vocal cord dysfunction (VCD). Because of the conviction of possible lung injury, the individual applies the fetal protective glottic closure reflex to counteract an odorant cue instigating acute VCD. Breathing against an obstructed glottis as well as hyperventilation from anxiety, panic and/or fear of personal harm worsens the laryngeal spasm. Spirometer shows flattening of the inspiratory loop of the flow-volume curve and endoscopy, while not done, would reveal adduction of the anterior two-thirds of the vocal cords with posterior chinking creating a diamond shape configuration. Successful therapy and management of VCD requires a speech therapy approach rather than physician prescribed medications.

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“…Eur Respir J., 1995Respir J., , 8, 1978Respir J., -1981 Vocal cord dysfunction secondary to psychogenic factors (PVCD) was first recognized in 1974, presenting as organic upper airways obstruction [1]. Presentations with a picture simulating bronchial asthma were later described.…”

Section: P Ps Sy Yc Ch Ho Og Ge En Ni Ic C V Vo Oc Ca Al L C Co or Rdmentioning

confidence: 99%

Psychogenic vocal cord dysfunction simulating bronchial asthma

Mobeireek¹,

Alhamad²,

Al-Subaei³

et al. 1995

Eur Respir J

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P Ps sy yc ch ho og ge en ni ic c v vo oc ca al l c co or rd d d dy ys sf fu un nc ct ti io on n ssi im mu ul la at ti in ng g b br ro on nc ch hi ia al l a as st th hm ma a We report three Saudi females with this condition, in whom polygamy and a large family system created associated social stress. Spirometry with a flow-volume loop showed characteristic features, and in all three this test was the most important clinical tool that led to the correct diagnosis.Clinicians should perform spirometry and flow-volume loop tests routinely in patients presenting with asthmatic symptoms, and look for clues suggestive of this condition, including a psychosocial assessment. Eur Respir J., 1995Respir J., , 8, 1978Respir J., -1981 Vocal cord dysfunction secondary to psychogenic factors (PVCD) was first recognized in 1974, presenting as organic upper airways obstruction [1]. Presentations with a picture simulating bronchial asthma were later described. A recent review summarized 48 cases found in the English language literature [2]. Interest in this condition is focused both on features that may help in its recognition and, therefore, avoid the serious consequences resulting from misdiagnosis, and on the underlying psychodynamics. We report, for the first time to our knowledge, three patients from the Middle East region, and discuss the relevance of cultural stresses and diagnostic clues, particularly the flowvolume loop. Case reportsCase No. 1 A 40 year old woman was admitted to hospital with moderate and severe attacks of bronchial asthma on eight occasions between 1988 and 1992. She was first labelled asthmatic after admission to another hospital in Riyadh in 1986. These attacks were characterized by dyspnoea, cough and wheeze, with no clear precipitating factors, except on two of her admissions where a history of a flu-like illness was given. There was no history of other atopic disorders and no family history of asthma.On examination, the patient was tachypnoeic and tachycardic, and diffuse inspiratory and expiratory rhonchi were heard. Multiple investigations were performed including full and differential blood counts, chest roentgenography, computed tomography of the chest and electrcardiography which revealed no abnormality. Initial arterial oxygen tension (Pa,O 2 ) ranged 7.9-8.4 kPa and arterial carbon dioxide tension (Pa,CO 2 ) was in the normal range, except during her two intensive care admissions when she developed CO 2 retention with acidosis. She was refractory to high dose parenteral corticosteroids.Peak expiratory flow rate values were erratic. Spirometric values in 1991 were: forced expiratory volume in one second (FEV1): 1.5 L (62% of predicted); forced vital capacity (FVC) 1.6 L (55% pred); and maximum expiratory flow at 50% of vital capacity (MEF50) 2.4 L·s -1 (55% pred). In 1992, values were: FEV1 2.3 L (92% pred); FVC: 2.6 L (86% pred), and MEF50 4.2 L·s -1 (94% pred). There was no significant change in these values after giving a bronchodilator. Inspiratory flows were reduced on both occasions, ...

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Munchausen's stridor: non‐organic laryngeal obstruction

Cited by 201 publications

References 1 publication

Vocal cord dysfunction: what do we know?

Vocal cord dysfunction: what do we know?

Vocal Cord Dysfunction after an Inhalation Exposure

Psychogenic vocal cord dysfunction simulating bronchial asthma

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