Laryngeal hypersensitivity in the World Trade Center-exposed population: the role for respiratory retraining.

Upper airway symptoms among responders to the terrorist attack on 9/11 are progressive and multifactorial. For those symptoms that are laryngeal in origin, we are using a multidisciplinary approach that includes respiratory retraining and laryngeal desensitization through a speech pathologist trained in airway disorders. Our treatment paradigm and laryngeal hypersensitivity are discussed in this essay.

Botulinum toxin treatment of adductor spasmodic dysphonia: longitudinal functional outcomes.

OBJECTIVES: Laryngeal botulinum toxin (BoNT) injection is a well-established symptomatic treatment for adductor spasmodic dysphonia (AdSD). Injections may be followed by a period of muscle weakness characterized by breathiness, voice weakness, and dysphagia for liquids. A recent study described some detriment and limited functional improvement with "good voice" for only one-third of the period between successive injections. Our objective was to examine the longitudinal effect of BoNT treatment for AdSD upon functional outcomes and quality of life when using a patient-specific dosing regimen. STUDY DESIGN: Prospective cohort study. METHODS: Patients presenting for BoNT treatment of AdSD were asked to complete evaluation of voice function after each injection using the percentage of normal function (PNF) scale (daily for two weeks, then weekly). Other parameters measured included voice handicap index (VHI), duration of effect, and complications. RESULTS: A total of 133 patients treated continuously between January 2006 and January 2009 with an individuated regime (dose, pattern, and schedule) were included. Of 1,457 treatments, 50.9% experienced some breathiness. Mean VHI improvement was 9.6%. Mean PNF improvement was 30.3%. There was correlation between the two scales. Dysphagia to liquids was reported after 14.2% of treatments. We describe two distinct types of functional outcome curve. A total of 28.5% of treatments were followed by initial functional decline. Mean time below baseline function was 5.7%. Mean proportion of time in plateau phase was 42.5%. CONCLUSIONS: It is important to consider longitudinal functional outcomes in BoNT treatment of AdSD. An individuated dosing regimen helps minimize side effects and maximize functional and quality-of-life outcomes.

[Favorable course of Lance-Adams postanoxic action myoclonus]. / Syndrome de Lance et Adams d'évolution favorable.

Clinical and electrophysiologic data concerning the postanoxic action myoclonus syndrome were described by Lance and Adams in 1963. A patient presented myoclonus involving all parts of the body after laryngospasm. The myoclonus was worsened by emotion and voluntary activity and was clearly attenuated by sleep. Spectacular improvement was observed within one week after valproate and piracetam administration. Clinicians should be aware of this syndrome in order to propose appropriate treatment and avoid delay in the therapeutic decision.

[Do psychological factors change in patients with spasmodic dysphonia after injections with botulinum-toxin?]. / Verändern sich psychologische Faktoren bei Patienten mit spasmodischer Dysphonie nach Botulinum-Toxin-Injektion?

OBJECTIVE: A pre-/posttherapeutic comparative study was carried out to investigate possible associations of voice symptoms, selected psychological factors and their changing. SAMPLE: A total of 11 patients with spasmodic dysphonia (adductor-type) subjected to botulinum-toxin-therapy. Patients had received treatment without any complications for at least 2 years. During that period of time, they received a minimum of 3 and a maximum of 9 injections (mean: 6). METHODS: Psychosocial data were measured before and after treatment using standardized psychological methods. The time span between measurements ranged from 1;8 to 4;6 years, with an average of 2;1 years. RESULTS: On average, no somatic disorder, no clinically meaningful states of anxiety or pathological manifestations of personality traits could be detected, neither pre- nor posttherapeutically. The average stress load caused by life-changing-events was unobtrusive. Before treatment, 5 of 11 patients had an affective disorder in terms of a depressed mood. This caused a higher than average mean depressivity score for the group as a whole. It was no longer found posttherapeutically. CONCLUSION: The depression is interpreted as a psychic reaction. An association between spasmodic voice symptoms and psychosocial genesis could not be proved.

[Not all wheezing is asthma: on functional laryngospasm]. / Nicht alles was pfeift ist Asthma: Zum funktionellen Laryngospasmus.

Functional disturbances of the larynx can obstruct respiratory airflow resulting in dramatic states of dyspnoea or shortness of breath. Whereas in inspiratory functional laryngospasm the diagnosis is suggested by inspiratory stridor and hoarseness, it is often difficult to differentiate between the two expiratory forms, namely, laryngospasm in asthma and laryngeal pseudoasthma on the one hand, and an obstructive disease of the lower respiratory tract on the other. Seven case reports demonstrate the by no means uniform pattern of symptoms, the diagnostics and the unfortunately not always satisfactory possibilities of treatment. Pulmonary functional analysis and laryngoscopy are the most important diagnostic procedures in this regard. Even if it is not always possible to achieve the desired freedom from symptoms by means of respiratory therapy, logopaedics or psychotherapy, a correct diagnosis will nevertheless protect both the patient and the doctor against further useless attempts at drug treatment.

[Episodic laryngeal dyskinesia: a functional cause of stridor]. / La dyskinésie laryngée épisodique: une cause fonctionnelle de stridor.

We present five cases of episodic laryngeal dyskinesia. This term describes an entity associating acute dyspnea with inspiratory and/or expiratory stridor, sometimes ending in acute respiratory distress. The origin of this trouble comes from paradoxal contraction of the vocal cords, which is reversible and recurrent. The clinical presentation presents as a differential diagnosis for serious disorders such as bronchial asthma, laryngeal oedema, or stenosing lesions of the upper airways. The definitive diagnosis is made by excluding organic pathology, by visualising laryngeal spasm and by the inspection of flow volume curve. A comparison of all the published papers since 1974 reveals the benign nature of this "noisy" disorder and to bring out the diagnostic criteria thus avoiding too aggressive an approach in these patients.