Evaluation of paradoxical vocal cord motion and differential diagnosis

Abstract

Objective: To evaluate the relationship between paradoxical vocal cord motion (PVCM) disease and the diseases such as asthma, laryngopharyngeal reflux and anxiety disorder that should be taken into consideration most frequently in differential diagnosis. Methods: The study included 100 patients (64 females and 36 males) who had applied to the polyclinics of pulmonary diseases, gastroenterology, psychiatry and ear nose throat due to respiratory symptoms. In asymptomatic period, it was planned to diagnose paradoxical vocal cord motion due to inspiratory adduction and posterior glottic fissure observed in videolaryngoscopic examination made after provocative maneuvers. Results: The mean age of the patients was 44.7±7.3 (female: 36.3±4.5, male: 52.3±3.2). 57% of the patients applied to pulmonary diseases, 24% to gastroenterology, 12% to psychiatry and 7% to ENT polyclinics. No paradoxical vocal cord motion was detected in 99 patients invideolaryngoscopic examination made after provocative maneuvers performed in asymptomatic period. Paradoxical vocal cord motion was detected in one patient who had attack during videolaryngoscopic examination. Conclusion: Although PVCM is a rarely seen disease, it leads to serious problems in non-diagnosed patients. In our study, we concluded that PVCM can be diagnosed during an attack rather than provocativemaneuvers performed during asymptomatic period.

Keywords

• Paradoxical vocal cord motion, asthma, laryngopharyngeal reflux, anxiety disorder

Vokal kordun paradoks motilitesinin ve ayırıcı tanısının değerlendirmesi

Öz

Amaç: Çalışmanın amacı, paradoks vokal kord motilitesi hastalığının, ayırıcı tanıda en büyük sıklıkla hesaba katılması gereken astım, larengogarengeal reflü ve anksiyete bozukluğu ile ilişkisini değerlendirmektir. Yöntem: Bu çalışmaya akciğer hastalıkları, gastroenteroloji, psikiyatri ve respiratuar semptomlar nedeniyle kulak burun boğaz polikliniklerine başvuran 100 (64 kadın ve 36 erkek) hasta dahil edilmiştir. Asemptomatik dönemde inspiratuar addüksiyona bağlı paradoks vokal kord motilitesine ve provokatif manevralar sonrasında videolarengoskopik muayenede gözlemlenen posterior glotik fissüre tanı konması planlanmıştır. Bulgular: Hastaların yaş ortalaması 44.7±7.3 (kadın: 36.3±4.5, erkek: 52.3±3.2) idi. Hastaların %57'si akciğer hastalıkları, %24'ü gastroenteroloji, %12'si psikiyatri ve %7'si KBB polikliniklerine başvurmuştu. Asemptomatik dönemde provokatif manevralar sonrası yapılan videolarengoskopik muayenede 99 hastada paradoks vokal kord motilitesi saptanmamıştır. Videolarengoskopik muayene sırasında atak oluşan bir hastada paradoks vokal kort motilitesi saptanmıştır. Sonuç: Paradoks vokal kord motilitesi nadiren görülen bir hastalık olmasına rağmen tanı konmamış hastalarda ciddi sorunlara yol açar. yol açar. Çalışmamızda, bu hastalığın tanısının, asemptomatik dönemde gerçekleştirilen provokatif manevralardan ziyade, atak sırasında konabileceği sonucuna vardık.

Anahtar Kelimeler

• Paradoks vokal kord motilitesi, astım, larengofarengeal reflü, anksiyete bozukluğu

Kaynakça

1. Matrka L. Paradoxic vocal fold movement disorder. Otolaryngol Clin North Am 2014;47:135–46.
2. Forrest LA, Husein T, Husein O. Paradoxical vocal cord motion: classification and treatment. Laryngoscope 2012;122:844–53.
3. Christopher KL, Wood RP 2nd, Eckert RC, Blager FB, Raney RA, Souhrada JF. Vocal cord dysfunction presenting as asthma. N Engl J Med 1983;308:1566–70.
4. Brugman SM. The many faces of vocal cord dysfunction. Am J Resp Crit Care Med 2003;167:A588.
5. Yilmaz A, Guven M, Eyibilen A, Aladag I. Paradoxical vocal fold motion dysfunction in asthma patients. Respirology 2009;14: 729–33.
6. Yelken K, Güven M, Alada¤ I, Eyibilen A. Relations between symptoms, durations and triggers of attacks and concurrent dis- eases in paradoxical vocal fold movement disorder. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2009;19:16–21.
7. O’Connell M. Vocal cord dysfunction: ready for prim-time? Ann All Asthma Imm 2006;96:762–3.
8. Mathers-Schmidt BA. Paradoxical vocal cord motion: a tutorial on a complex disorder and the speech language pathologist’s role. Am J Speech Lang Pathol 2001;10:111–25.

9. Christopher KL. Understanding vocal cord dysfunction: a step in the right direction with a long road ahead. Chest 2006;129:842–3.
10. Dogan S, Eryuksel E, Karakurt S. Paradoxical vocal cord adduc- tion: a case report. Medscape Allergy Clin Immunol 2002;2:1–7.
11. Murkami Y, Kirchner J. Mechanical and physiological properties of reflexlaryngeal closure. Ann Otol 1972;81:59–72.
12. Jain S, Bandi V, Officer T, et al. Role of vocal cord function and dysfunction inpatients presenting with symptoms of acute asthma exacerbation. J Asthma 2006;43:207–12.
13. Kenn K, Willer G, Bizer C, et al. Prevalence of vocal cord dys- function in patients with dyspnoea. First prospective clinical study. Am J Respir Crit Care Med 1997;155:A965.
14. Kenn K, Balkissoon R. Vocal cord dysfunction: what do we know? Eur Respir J 2011;37:194–200.
15. Brugman SM, Simon SM. Vocal cord dysfunction: don’t mistake it for asthma. Physician Sports Med 1998;26:63–74.
16. Bahrainwala AH, Simon MR. Wheezing and vocal cord dysfunc- tion mimicking asthma. Curr Opin Pulm Med 2001;7:8–13.
17. O’Connell MA, Sklarew PR, Goodman DL. Spectrum of presen- tation of paradoxical vocal cord motion in ambulatory patients. Ann All Asthma Imm1995;74:341–4.
18. Powell DM, Karanfilov BI, Beechler KB, et al. Paradoxical vocal cord dysfunction in juveniles. Arch Otolayngol Head Neck Surg 2000;126:29–34.
19. Ayers JG, Gabbott PLA. Vocal cord dysfunction and laryngeal hyperresponsiveness: a function of altered autonomic balance? Thorax 2002;57:284–5.
20. Selner JC, Staudenmayer H, Koepke JW, et al. Vocal cord dys- function: the importance of psychological factors and provocation challenge testing. J Allergy Clin Immunol 1987;79:726–33.
21. Bahrainwala AH, Simon MR. Wheezing and vocal cord dysfunc- tion mimicking asthma. Curr Opin Pulm Med 2001;7:8–13.
22. Newman KB, Mason UG, Schmaling KB. Clinical features of vocal corddysfunction. Am J Respir Crit Care Med 1995;152: 1382–6.
23. Jain S, Bnadi V, Zimmerman J, et al. Incidence of vocal cord dys- function inpatients presenting to emergency room with acute asthma exacerbation. Chest 1999;116:243.
24. Ibrahim WH, et al. Paradoxical vocal cord disorder: past, present and future. Postgrad Med J 2007;83:164–72.
25. Heimdal JH, Roksund OD, Halvorsen T, Skadberg BT, Olofsson J. Continuous laryngoscopic exercise test: a method for visualizing laryngeal dysfunction during exercise. Laryngoscope 2006;116: 52–7.
26. Suttithawil W, Chakkaphak S, Jaruchinda P, et al. Vocal cord dys- function with a nutcracker esophagus and the role of gastroe- sophageal reflux disease. Ann All Asthma Imm 2006;96:373–5.
27. Kisson N, Kornick JB, Frewen TC. Psychogenic upper airway obstruction. Pediatrics 1988;81:714–17.
28. Balkissoon R, Kenn K. Asthma: vocal cord dysfunction (VCD) and other dysfunctional breathing disorders. Semin Respir Crit Care Med 2012;33:595–605.
29. Ibrahim WH, Gheriani HA, Almohamed AA, Raza T. Paradoxical vocal cord motion disorder: post, present and future. Postgrad Med J 2007; 83: 164–72.
30. Karaman E, Duman C, Alimoglu Y, Isildak H, Oz F. Paradoxical vocal cord motion-haloperidol usage in acute attack treatment. J Craniofac Surg 2009;20:1602–4.
31. Garibaldi E, LeBlance G, Hibbett A, et al. Exercise induced para- doxical vocal cord dysfunction: diagnosis with videostroboscopic endoscopy and treatment with Clostridium toxin. J Allergy Clin Immunol 1993;91(1 Part 2):200.
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35. Please cite this article as: Yalçınkaya E, Güler ‹, Kocatürk S. Evaluation of paradoxical vocal cord motion and differential diagnosis. J Med Updates 2014;4(3):99–104.