A case of vocal cord dysfunction in the emergency department

Submitted: 27 March 2022
Accepted: 18 May 2022
Published: 27 June 2022
Abstract Views: 931
PDF: 232
Video: 76
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

We describe the case of a 78-year-old woman admitted to our emergency department for an acute onset of severe dyspnoea with inspiratory wheezing-like sounds. She denied fever, cough, voice change and pain. She referred a similar but less severe episode occurred spontaneously one year before, with complete resolution in few minutes without sequelae. On examination upper airway obstruction was firstly excluded. She was initially treated as having asthma, without response. Parenteral high dose corticosteroids and antihistamines provided no benefit. Point-of-care-ultrasound resulted normal. Flexible laryngoscopy during the episode showed paradoxical vocal cord movement with adduction during both inspiration and expiration. This demonstrated that her dyspnoea was from Vocal Cord Dysfunction (VCD). VCD completely solved after administration of intravenous benzodiazepines.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Dunglison R. Practice of Medicine; or a treatise on special pathology and therapeutics. Phladelphia, Lea & Blanchard, 1842. DOI: https://doi.org/10.1097/00000441-184204000-00009
Patterson R, Schatz M, Horton M. Munchausen’s stridor: non-organic laryngeal obstruction. Clin Allergy 1974;4:307–310. DOI: https://doi.org/10.1111/j.1365-2222.1974.tb01390.x
Weinberger M, Doshi D. Vocal cord dysfunction: a functional cause of respiratory distress. Breathe (Sheff) 2017;13:15-21. DOI: https://doi.org/10.1183/20734735.019316
Dunn NM, Katial RK, Hoyte FCL. Vocal cord dysfunction: a review. Asthma Res Pract 2015;1:9. DOI: https://doi.org/10.1186/s40733-015-0009-z
Morrison M, Rammage L, Emami AJ. The irritable larynx syndrome. J Voice 1999;13:447–55. DOI: https://doi.org/10.1016/S0892-1997(99)80049-6
Andrianopoulos MV, Gallivan GJ, Gallivan KH. PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it? J Voice 2000;14:607–18. DOI: https://doi.org/10.1016/S0892-1997(00)80016-8
Rundell KW, Spiering BA. Inspiratory stridor in elite athletes. Chest 2003;123:468–74. DOI: https://doi.org/10.1378/chest.123.2.468
Goldstein R, Bright J, Jones SM, et al. Severe vocal cord dysfunction resistant to all current therapeutic interventions. Respir Med 2007;1:857–8. DOI: https://doi.org/10.1016/j.rmed.2006.08.009
Newman KB, Mason UG 3rd, Schmaling KB. Clinical features of vocal cord dysfunction. Am J Respir Crit Care Med 1995;152:1382–6. DOI: https://doi.org/10.1164/ajrccm.152.4.7551399
Christopher KL, Wood RP 2nd, Eckert RC, et al. Vocal-cord dysfunction presenting as asthma. N Engl J Med 1983;308:1566–70. DOI: https://doi.org/10.1056/NEJM198306303082605
Greenlee JDW, Donovan KA, Hasan DM, et al. Chiari I malformation in the very young child: the spectrum of presentations and experience in 31 children under age 6 years. Pediatrics 2002;110:1212–9. DOI: https://doi.org/10.1542/peds.110.6.1212
Hilland M, Røksund OD, Sandvik L, et al. Congenital laryngomalacia is related to exercise induced laryngeal obstruction in adolescence. Arch Dis Child 2016;101:443–8. DOI: https://doi.org/10.1136/archdischild-2015-308450
Morris MJ, Christopher KL. Diagnostic criteria for the classification of vocal cord dysfunction. Chest 2010;138:1213–23. DOI: https://doi.org/10.1378/chest.09-2944
Murry T, Tabaee A, Aviv JE. Respiratory retraining of refractory cough and laryngopharyngeal reflux in patients with paradoxical vocal fold movement disorder. Laryngoscope 2004;114:1341–5. DOI: https://doi.org/10.1097/00005537-200408000-00005
Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997;36:1329–38. DOI: https://doi.org/10.1097/00004583-199710000-00014
Selner JC, Staudenmayer H, Koepke JW, et al. Vocal cord dysfunction: the importance of psychologic factors and provocation challenge testing. J Allergy Clin Immunol 1987;79:726–33. DOI: https://doi.org/10.1016/0091-6749(87)90203-X
Powell DM, Karanfilov BI, Beechler KB, et al. Paradoxical vocal cord dysfunction in juveniles. Arch Otolaryngol Head Neck Surg 2000;126:29–34. DOI: https://doi.org/10.1001/archotol.126.1.29
Miller S. Voice therapy for vocal fold paralysis. Otolaryngol Clin North Am 2004;37:105–19. DOI: https://doi.org/10.1016/S0030-6665(03)00163-4
Earles J, Kerr B, Kellar M. Psychophysiologic treatment of vocal cord dysfunction. Ann Allergy Asthma Immunol 2003;90:669–71. DOI: https://doi.org/10.1016/S1081-1206(10)61874-1
Anbar RD, Hehir DA. Hypnosis as a diagnostic modality for vocal cord dysfunction. Pediatrics 2000;106:e81. DOI: https://doi.org/10.1542/peds.106.6.e81
Morris MJ, Allan PF, Perkins PJ. Vocal cord dysfunction: etiologies and treatment. Clin Pulm Med 2006;13:73–86. DOI: https://doi.org/10.1097/01.cpm.0000203745.50250.3b
Slinger C, Slinger R, Vyas A, et al. Heliox for inducible laryngeal obstruction (vocal cord dysfunction): A systematic literature review. Laryngoscope Investig Otolaryngol 2019;4:255-8. DOI: https://doi.org/10.1002/lio2.229
Fowler SJ, Thurston A, Chesworth B, et al. The VCDQ - a questionnaire for symptom monitoring in vocal cord dysfunction. Clin Exp Allergy 2015;45:1406-11. DOI: https://doi.org/10.1111/cea.12550
Mahoney J, Hew M, Vertigan A, Oates J. Treatment effectiveness for vocal cord dysfunction in adults and adolescents: A systematic review. Clin Exp Allergy 2022;52:387-404. DOI: https://doi.org/10.1111/cea.14036
George S, Suresh S. Vocal cord dysfunction: Analysis of 27 cases and updated review of pathophysiology & management. Int Arch Otorhinolaryngol 2019;23:125-30. DOI: https://doi.org/10.1055/s-0038-1661358

How to Cite

Poggiali, E., Di Trapani, G., Agosti, A., Caiazza, C., Manicardi, A., Zanzani, C., Vollaro, S., & Vercelli, A. (2022). A case of vocal cord dysfunction in the emergency department. Emergency Care Journal, 18(2). https://doi.org/10.4081/ecj.2022.10483