Vocal Cord Dysfunction bei Kindern und Jugendlichen

Abstract

More attention has been given to vocal cord dysfunction (VCD) in the past years. Even though the disease is known since 1983 and was brought to mind at least casuistically through the years, often VCD was not diagnosed as such, being mistaken for bronchial asthma - at times with grave consequences for the patient. VCD causes the acute onset of stridulous respiration with acute dyspnea making the differential diagnosis of asthma quite suggestive. The inspirational stridor and a peracute progression of the disease should cause doubts as to the diagnosis of asthma. We collected case reports and describe the symptoms and diagnostic approaches to VCD as well as showing discriminating findings towards bronchial asthma. We report on five children suffering from VCD (4 girls, 1 boy) aged from 2 to 13 years. It could be shown that VCD is caused by a multifactoral pathomechanism, which has both somatic and psychological aspects. A surprising find was that all of the children were diagnosed with a pathological gastroesophageal reflux, partly in serious dimensions, without showing the typical symptoms such as retrosternal pain, stomach-ache or recurrent vomiting (so called silent reflux). Since there is a multitude of pathomechanisms involved and the disease often coincides with allergic asthma, an individual therapy plan is needed for each patient.

Vocal Cord Dysfunction Without End?

“…VCD presents with bouts of paradoxical vocal fold adduction of unknown origin. Proposed risk factors are i. e. gastro-esophageal refl ux [1,8] , rhinitis / sinusitis [4] , coincidence with bronchial asthma [3] , psychopathological factors [1] , female gender [1, 6 -8] , young age (20 -40 J [7] , as well as the early teenage-years of 14 -15 years in pediatric studies [6,8,9] ) and sports [1] . Our case report appears closely related to VCD by its functional character ( • ▶ Table 1 ).…”

“…Our patient did not show any clinical symptoms of a gastro-esophageal refl ux. Taking into account that in some cases of VCD asymptomatic gastro-esophageal refl ux could be demonstrated [1] , we initiated treatment with omeprazole renouncing at further diagnostics. Another pivotal therapeutic approach was voice therapy.…”

Vocal Cord Dysfunction

“…Als mögliche Faktoren,die eine VCD begüns-tigen bzw.auslösen können,wurden neben einem Asthma bronchiale ein laryngopharyngealer Reflux [1,7],psychogene Ursachen [5,6], allergische Reaktionen [15], Hirnstammkompressionen [10],eine zystische Fibrose [18] etc. diskutiert.…”