Vocal Cord Dysfunction

Question 1

Asthma vs. VCD-SPO2

Answer 1

Asthma-SpO2 Low

VCD-SpO2 normal (absence of hypoxemia)

Question 2

VCD Clinical Manifestations

Answer 2

• Rapid onset and sudden resolution
• Sore throat/hoarsness/laryngitis
• Throat tightness/chocking sensation
• Panic and fear of impending doom
• Dysphonia-voice change during attack
• Barky cough
• Retraction
• Chest tightness
• Substernal Chest
  
  • Pain, burning
• Cyanosis
  
  • if severe
• Severe agitation
• Dizziness and decrease LOC
• Dsyphagia-difficultly in swallowing which can lead to choking

Question 3

VCD Asthma Like Symptons

Answer 3

On Exertion

Dsypnea/SOB or may have tachypnea due to hyperventilation

Wheeze

Question 4

VCD-Treatment

Answer 4

Indentify and stop unecessary treatment

Speech Therapy

Breathing Exercises

Relaxation Techniques-For neck, shoulder, chest, and oropharyngeal mus.

Heliox Therapy-In severe cases

CPAP

Intubation or Trachestomy

Inhaled Anticholinergic Agents (Atrovent)-May be helpful in exercise induced

Boltulinum Toxin (Botox)

Hypnosis and Pstchotherapy-Used if there is also underlying conditions

Antidepressants and Antioxlytics-Not used if there is underlying psychiatric conditions

Question 5

Which of the following can be associated with vocal cord dysfunction?

i. Inspiratory stridor
ii. Dysphonia
iii. Expiratory wheezing
iv. Cyanosis

Answer 5

i, ii, iv

Question 6

VCD Males versus Females

Answer 6

More common in females

Question 7

VCD Irritants

Answer 7

Irritants such as dust, smoke, chemicals, medications, foods, GERD, URI, can all trigger attacks

Question 8

True or False: Vocal cord dysfunction is more often observed in males than in females.

Answer 8

False

Question 9

Vocal Cord Dsyfunction Definition

Answer 9

Abnormal adduction of the vocal cords, usually on inspiration, producing an obstruction in he airway at the larynx cauing wheezing and occasionally stridor

Characterized by a struturally normal but functionally abnormal larynx. There are no bio-chemical, physiologic, or structural abnormalities.

Also known as “Paradoxical Vocal Cord Motion”

Question 10

VCD and Asthma Co-Exist

Answer 10

Can co-exist with asthma, but it is frequently mistaken for asthma that is unresponsive to therapy (~40%)

If the patient has both asthma and VCD, it is important to control the VCD as well as the asthma. Relieving the asthma may allow the patient to relax enough to control their VCD. Reversing the VCD also may help resolve the patient asthma.

Question 11

VCD and Psychogenic Factors

Answer 11

Stress can be a trigger

VCD has lead to several near drownings in competitive swimmers

No voluntary componenets

Question 12

In acute vocal cord dysfunction, the vocal cords:

Answer 12

Close on inspiration

Question 13

VCD-Laryngoscope

Answer 13

The gold standard in disgnosis VCD

When presnet will show an adduction of 2/3 of the vocal cords and a posterior chinking (diamond shape), primaryily during inspiration (maybe expiration) during an attack as asymptomatic patients will look normal

There will be no chink with a complete closure in children

May use exercise or bronchial challenges in order to induce symptons

Question 14

VCD vs. Asthma: A-a Gradient

Answer 14

Asthma: A-a Gradient high

VCD: A-a Gradient normal

Question 15

VCD Etiology

Answer 15

Etiology is unknown

Obesity is a common feature

Question 16

Which of the following would be considered as part of the interventions for acute vocal cord dysfunction?

i. Psychotherapy
ii. Heliox
iii. Valium
iv. Botox injections

Answer 16

ii, iii, iv only

Question 17

VCD Age of Onset

Answer 17

3+ Years

Often between 20-40

Question 18

VCD and PFT- Symptomatic

Answer 18

A flattened inspiratory limb (bottom portion) with variable extrathoracic or fixed obstruction

Normal expiratory flow (upper portion)

Spirometry is only suggestive not diagnostic

Question 19

VCD-Boltulinum Toxin (Botox)

Answer 19

Intralaryngeal injection

Blocks Ach release creating larayngeal muscle weakening

Considered experimental

Tropicial Lidocain-Breaks cycle of hyperactive glottal and supraglottal muscle contractions

Question 20

VCD-Breathing Exercises

Answer 20

Practice asymptomatic

Sniff Lung-Breathing technique of shallow panting

Abdominal Breathing-Slow inhalation through a relaxed throat by placing tongue on the floor of the mouth behind the lower front teeth while partially closing lips as abdomen expands. Exhalation with a gentle ‘s’ sound

Question 21

VCD and Occupation

Answer 21

More common in healthcare professioanls

Question 22

VCD and Stridor

Answer 22

VCD will have inspiratory stridor (rarly expiratory)

Question 23

VCD History

Answer 23

There will often be a history of frequent visist to the ER

Question 24

VCD Attacks versus Asthma Attacks

Answer 24

VCD attack generally occur in the day and unlike asthma there will be no nocturnal awakenings

Question 25

VCD-Speech Therapy

Answer 25

First line of defense Decreased laryngeal muscle tone by focusing on expiration instead of inspiration

Question 26

VCD and Physical Exam

Answer 26

The physical exam is a poor indicator of VCD

Question 27

Differential Diagnosis

Answer 27

* Other causes of airway obstruction * Bilateral vocal cord dsyfunction **(most common)** * Laryngospasm in children * Laryngeal Edema due to anaphylactic reaction * Associated with hypertension and utlcaria * Neoplasm * TB * Foriegn body aspiration * hypertropic tonsils * Gioter * Medistinal infection

Question 28

Asthma vs. VCD-Dsypnea

Answer 28

Asthma-Usully expiratory difficulties VCD-usually inspirtory difficulties

Question 29

Asthma vs. VCD-Wheezes

Answer 29

Asthma-Wheezes heard throughout the chest, expirtory wheezes present, inspiratory wheezes may or may not be present VCD-Wheezes loudest over the larynx, expirtory wheezes absent, inspiratory wheezes present

Question 30

VCD and PFT- Asymptomatic

Answer 30

Normal with no response to bronchodilators Normal lung volumes-Asthmatics can have a high residual volume