Vocal Cord Dysfunction With Acute Respiratory Failure that Required Repeated Intubation

Abstract

Vokal kord disfonksiyonu, laringeal wheezing ya da laringeal astım olarak da bilinen bozukluk, vokal kordların inspiryum süresince paradoksal olarak kapanıp, obstrüktif hava yolu semptomlarına yol açması ile karakterizedir. Mekanizma tam olarak bilinmemekle birlikte psikojenik faktörlerin ön planda sorumlu olduğu düşünülmektedir. Hastalığın şiddeti hafif dispneden entübasyon ya da trakeostomi gerektiren solunum yetmezliğine kadar değişir. Wheezing, stridor ve nefes darlığı tipik bulgulardandır. Hastalığın tanısı semptomatik dönemde yapılan laringoskopi ile vokal kordların paradoksal hareketinin gözlenmesi ile konulur. Bu olgu sunumunda, acil servise entübasyon gerektiren akut solunum yetmezliği ile başvuran, takiplerinde 3 kez daha entübe edilen, daha sonra vokal kord disfonksiyonu tanısı konularak lazer kordotomi ile tedavi edilen 70 yaşında bayan hasta tartışılmaktadır. Anahtar Sözcükler: Vokal kord disfonksiyonu, solunum yetmezliği, tekrarlayan entübasyon.Vocal cord dysfunction, also known as laryngeal wheezing or laryngeal asthma, is a disorder characterized by paradoxical closure of the vocal cords intermittently during inspiration and causing obstructive airway symptoms. The mechanism is unclear, but is thought to be responsible for psychogenic factors in the foreground. Severity of the disease varies from mild dyspnea to respiratory failure with requiring intubation or tracheostomy. Wheezing, stridor and dyspnea are the typical symptoms. Diagnosis is made by observation of paradoxical vocal cords movement by laryngoscopy, during symptoms. In this case report, a 70 year old female patient was discussed, who presented with acute respiratory failure with requiring intubation in the emergency room, and in the days that followed was intubated 3 more times. At the end the diagnosis was vocal cord dysfunction and treated with laser cordotomy.

A case of paradoxical vocal cord movement misdiagnosed as anaphylaxis

“…If these patients cannot be correctly diagnosed, their conditions may be confused with, e.g., anaphylaxis or asthma, and may patients be exposed to unnecessary treatments. Furthermore, they could be exposed to serious conditions such as repeated intubation due to acute attacks of respiratory failure [ 15 , 16 ].…”