A treatment for vocal cord dysfunction in female athletes: an outcome study.

OBJECTIVES: This article reports the outcome of a speech pathology treatment program for vocal cord dysfunction (VCD) in 20 adolescent female athletes. STUDY DESIGN: A retrospective, nonrandomized group design was used to collect the outcome data. METHODS: Twenty consecutive referrals of female athletes diagnosed as having symptoms of VCD during exercise were assessed, treated, and followed for at least 6 months after treatment. RESULTS: Ninety-five percent of the participants reported the ability to control symptoms of VCD during exercise up to 6 months after treatment. Asthma medications were no longer used by 80% of the athletes. All of the females continued to participate in athletics. CONCLUSION: Speech pathology intervention focusing on respiratory control of VCD in adolescent female athletes is an effective treatment resulting in the athletes' ability to control the symptoms of VCD in exercise for at least 6 months after treatment.     

Suture lateralization of vocal cord treating paradoxical vocal cord movement: a case report

Paradoxical vocal cord movement (PVCM) causes inspiratory stridor and extra-thoracic airway obstruction through inappropriate adduction of the vocal cords during the respiratory cycle. We report on a patient with severe PVCM necessitating tracheostomy insertion. Using the technique of endoscopic suture lateralization of a vocal cord, we succeeded in decannulation 22 years after tracheostomy. PVCM of this severity is rare and its management remains unclear. Successful treatment in this manner has not been documented previously. A brief review of current management options for this condition is included.     

Paradoxical vocal cord movement in newborn and congenital idiopathic vocal cord paralysis: two of a kind?

The second most common cause of stridor reported in the newborn is bilateral vocal cord paralysis (BVCP) and one-third of the cases have been categorized as idiopathic. During the last year four children with stridor since birth were referred to our department for examination. Videotaped flexible laryngoscopy, carried out with the patient awake or under general anaesthesia with a spontanous respiration, revealed instead of abduction of the vocal cords during inspiration, rather an active adductory movement. Consequently instead of BVCP, we made the diagnosis paradoxical vocal cord movement (PVCM). One of the twins required a tracheostomy, the three other patients have been observed without the need of further treatment. No previous publications have described PVCM in newborn. However, our observations and video recordings clearly show that the stridor in our four patients is due to PVCM. This is possibly the same condition as earlier reported as congenital, idiopathic BVCP where incoordinated vocal cord movement or dyskinesia has been a part of the laryngoscopic findings. The mechanism behind PVCM in this age group or site of lesion is unclear.     

Formal psychological testing in patients with paradoxical vocal fold dysfunction

OBJECTIVE: The etiology of paradoxical vocal fold dysfunction (PVFD) has been unclear, but it has long been hypothesized that there is a significant psychological component. The purpose of this study was to elucidate the psychological profiles of patients newly diagnosed with PVFD using psychometrically-sound psychological assessment instruments. STUDY DESIGN: Prospective cohort study of 45 adults newly diagnosed with PVFD at a tertiary university referral center. METHODS: The Minnesota Multiphasic Personality Inventory (MMPI-2) was administered to test for psychopathology. The Life Experiences Survey (LES) was administered to investigate levels of stress. Demographic, medical, and social histories were reviewed. MMPI-2 and LES scores for the PVFD cohort were compared with scores previously established for normative populations. RESULTS: The study population included 81% female and 60% who were age 50 or older. Compared to the normative population for the MMPI-2, significant differences were noted for both male and female PVFD patients; on average, scores were highly elevated on the hypochondriasis scale and hysteria scale and less elevated on the depression scale. This pattern was consistent with conversion disorder (P < .01). In MMPI-2 subset analysis, 18 patients had a classic conversion profile while 13 others had elevated scores in the three scales of interest, but not in the classic conversion disorder pattern. Also, 11 patients had normal scores, suggesting no psychopathology. PVFD patients with a psychological history scored significantly higher on the depression and anxiety scales than PVFD patients without a psychological history. Patients with a history of asthma or gastroesophageal reflux disease (GERD) achieved significantly higher scores on the hypochondriasis scale than those without that medical history. On the LES assessment, female PVFD patients had significantly lower levels of positive stress and higher levels of negative stress than the general population; total levels of stress were not significantly different, however. Male PVFD patients had significantly lower levels of positive, negative, and total stress. For the entire cohort, asthma (65%), GERD (51%), and a history of abuse (38%) were common comorbidities. CONCLUSIONS: On average, in both male and female adults, PVFD is associated with conversion disorder, representing a physical manifestation of underlying psychological difficulty. There also appears to be a subset of PVFD that is not associated with psychopathology. PVFD patients with a previous psychological history are prone to more depressive and anxious symptomatology. Patients with PVFD and a history of asthma or GERD are more likely to excessively complain about physical symptoms. Overall levels of stress are not higher in PVFD patients compared to a general population. However, females report more negative stress, and both males and females may have trouble coping with the amount of stress that they do have. PVFD is more common among women, more prevalent among older individuals, and can be comorbid with asthma, GERD, and previous abuse. These results have implications for treatment- psychotherapy directed for somatoform and conversion disorders may be added to traditional speech therapy for increased efficacy.     

Paradoxical vocal cord motion: a review focused on multiple system atrophy

OBJECTIVE: Paradoxical vocal cord motion (PVCM) is a well recognized respiratory condition in which active adduction of the vocal cords during inspiration causes functional airway obstruction. It is considered that laryngeal reflex acceleration underlies the generation of nonorganic PVCM. In various situations producing PVCM, multiple system atrophy (MSA) is a representative neurological disease causing nocturnal laryngeal stridor attributed to PVCM. The purpose of this review is to identify the underlying mechanisms associated with nonorganic and MSA-related PVCM. The following issues are addressed in this review: (1) the pathophysiology of nonorganic and MSA-related PVCM, (2) the relationships between PVCM and airway reflexes, and (3) the treatment for MSA-related PVCM. METHODS: Review. RESULTS AND CONCLUSIONS: An abnormality of the laryngeal output-feedback control underlies nonorganic PVCM, which is usually triggered by an excessive response to external and internal airway stimuli. Similarly, several clinical and experimental evidence suggest that MSA-related PVCM is attributed to the airway reflex as well as to paradoxical central outputs resulting from the MSA-induced damage to the pontomedullary respiratory center. Application of continuous positive airway pressure (CPAP), which suppresses the reflexive inspiratory activation of adductors, is recommended as the treatment for MSA-related PVCM.     

Continuous laryngoscopy exercise test: a method for visualizing laryngeal dysfunction during exercise

OBJECTIVES/HYPOTHESIS: To assess the diagnostic feasibility and patient acceptance of a new developed diagnostic test for exercise induced upper airway flow limitation. STUDY DESIGN: Clinical case control study including evaluation of contemporary ergo-spirometry and laryngoscopy continuously performed during exercise. METHODS: Twelve nonsymptomatic controls and four young females with documented dyspnea and noisy breathing during exercise were studied. All subjects exercised to exhaustion on a treadmill while attached to a fully equipped ergo-spirometry unit and a fiberoptic laryngoscope linked to a video camera and a sound recorder. RESULTS: The test situation was well tolerated. Two control subjects had a minor inspiratory synchronous medial motion of the aryepiglottic folds without limitation of laryngeal airflow. In the four symptomatic subjects, exercise induced inspiratory synchronous medial motion of the dorsal part of the aryepiglottic folds as well as vocal cord adduction and inspiratory stridor was demonstrated. CONCLUSION: The continuous laryngoscopy exercise test was easy to perform, well tolerated, and can be implemented in future diagnostic work-up programs of laryngeal dysfunction.