Vocal Cord Dysfunction Flashcards
Asthma vs. VCD-SPO2
Asthma-SpO2 Low
VCD-SpO2 normal (absence of hypoxemia)
VCD Clinical Manifestations
- 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
VCD Asthma Like Symptons
On Exertion
Dsypnea/SOB or may have tachypnea due to hyperventilation
Wheeze
VCD-Treatment
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
Which of the following can be associated with vocal cord dysfunction?
i. Inspiratory stridor
ii. Dysphonia
iii. Expiratory wheezing
iv. Cyanosis
i, ii, iv
VCD Males versus Females
More common in females
VCD Irritants
Irritants such as dust, smoke, chemicals, medications, foods, GERD, URI, can all trigger attacks
True or False: Vocal cord dysfunction is more often observed in males than in females.
False
Vocal Cord Dsyfunction Definition
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”
VCD and Asthma Co-Exist
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.
VCD and Psychogenic Factors
Stress can be a trigger
VCD has lead to several near drownings in competitive swimmers
No voluntary componenets
In acute vocal cord dysfunction, the vocal cords:
Close on inspiration
VCD-Laryngoscope
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
VCD vs. Asthma: A-a Gradient
Asthma: A-a Gradient high
VCD: A-a Gradient normal
VCD Etiology
Etiology is unknown
Obesity is a common feature