Vocal Cord Dysfunction: Masquerader of Asthma

Newman, Ken; Dubester, Sherry N.

doi:10.1055/s-2007-1006358

Cited by 105 publications

(80 citation statements)

References 33 publications

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“…Typically, there is closure of the anterior two-thirds of the vocal cords with posterior chinking that creates a diamond shape (Figure 1a and b). Sometimes, patients are instructed to perform various maneuvers including sniff, sequential phonation, normal breathing, panting and repetitive deep breaths in order to fully evaluate vocal cord movement [8]. In contrast, the author's cases relied on spirometry utilizing a visual flow-volume tracing.…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…The cornerstone and most appropriate treatment for VCD is speech therapy [8,105]. Speech therapy utilizes techniques such as relaxedthroat breathing, respiratory retraining therapy and counseling on vocal hygiene [106].…”

Section: Managementmentioning

confidence: 99%

“…Speech therapy utilizes techniques such as relaxedthroat breathing, respiratory retraining therapy and counseling on vocal hygiene [106]. Patients are coached to practice relaxation technique several times a day without manifesting stridor or chest tightness [8]. Sometimes, employing biofeedback clarifies the correlation between the patient's throat-related tension and autonomic hyperarousal.…”

Section: Managementmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

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Vocal Cord Dysfunction after an Inhalation Exposure

Brooks¹

2017

J Allergy Ther

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“…The proposed mechanism is that these higher ventilation bursts require breathing more through the mouth, resulting in cooler and drier air than can irritate the vocal cords [8•]. PVFMD has been found to be present at rates of up to 40 % among patients with refractory or exercise-induced dyspnea [50,[57][58][59]…”

Section: Epidemiologymentioning

confidence: 99%

Dyspneic athlete

Krey

Best

2014

Curr Rev Musculoskelet Med

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Breathing concerns in athletes are common and can be due to a wide variety of pathology. The most common etiologies are exercise-induced bronchoconstriction (EIB) and paradoxic vocal fold movement disorder (PVFMD). Although some patients may have both, PVFMD is often misdiagnosed as EIB, which can lead to unnecessary treatment. The history and physical exam are important to rule out life threatening pulmonary and cardiac causes as well as common conditions such as gastroesophageal reflux disease, sinusitis, and allergic etiologies. The history and physical exam have been shown to be not as vital in diagnosing EIB and PVFMD. Improvement in diagnostic testing with office base spirometry, bronchoprovocation testing, eucapnic voluntary hyperpnea (EVH) and video laryngoscopy are essential in properly diagnosing these conditions. Accurate diagnosis leads to proper management, which is essential to avoid unnecessary testing and save healthcare costs. Also important to the physician treating dyspnea in athletes is knowing regulations on medications, drug testing, and proper documentation needed for certain organizations. The differential diagnosis of dyspnea is broad and is not limited to EIB and PVFMD. Ruling out life threatening cardiac and pulmonary causes with a proper history, physical, and appropriate testing is essential. The purpose of this review is to highlight recent literature on the diagnosis and management of EIB and PVFMD as well as discuss other potential causes for dyspnea in the athlete.

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