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1.
Arerugi ; 70(1): 33-38, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33597344

RESUMO

Although an important cause of vocal cord dysfunction (VCD) is psychogenic reaction, VCD may be associated with severe asthma and must be distinguished from the disease. A 30-years-old woman was admitted to our hospital with dyspnea despite treatment for asthma. Inspiratory stridor and expiratory wheezes were noted, and neck and chest computed tomography showed normal airways and lungs. Fractional exhaled nitric oxide levels were also normal. Pulmonary function test with a flow-volume loop curve showed normal expiratory loop with flattening of the inspiratory loop after methacholine inhalation. During the attack, bronchoscopy revealed the vocal cord closing with stridor during the inspiratory phase. Therefore, the patient was diagnosed with VCD. The dyspnea improved with respiratory rehabilitation and pursed-lip breathing. VCD should be considered in the differential diagnosis of intractable severe asthma. In this case, bronchoscopy and bronchial inhalation challenge with methacholine helped in the diagnosis.


Assuntos
Asma , Disfunção da Prega Vocal , Adulto , Asma/diagnóstico , Testes de Provocação Brônquica , Broncoscopia , Diagnóstico Diferencial , Feminino , Humanos , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia , Prega Vocal
2.
Arerugi ; 69(5): 353-357, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32684550

RESUMO

We present a case of a 17-year-old woman with a history of bronchial asthma since two years of age. She had daily asthma attacks from the age of fourteen, and the addition of oral corticosteroids and omalizumab to regular inhaled corticosteroid inhalation failed to relieve symptoms. She was referred to our hospital for detailed examination. On admission, physical examination was normal, but she had complained of dyspnea at the round. Monophonic wheezes and stridor were heard over the anterior neck, while no rales were audible over any part of the chest. Laryngoscopy revealed paradoxical movement of the vocal cords, and a diagnosis of vocal cord dysfunction (VCD) was made. The apparent severe asthma symptoms were considered to reflect VCD, and the treatment for bronchial asthma was stepped down without any recurrence of asthma attacks. Although the etiology of the VCD was unknown, VCD is more common in young women, so stress and personality factors are thought to be involved. It has been noted that childhood asthma often improves between childhood and adolescence, but refractory cases have been noted. In intractable bronchial asthma cases, it is necessary to consider the complications of other diseases, such as VCD, and to perform appropriate management.


Assuntos
Asma , Disfunção da Prega Vocal , Adolescente , Asma/diagnóstico , Asma/tratamento farmacológico , Diagnóstico Diferencial , Dispneia/diagnóstico , Feminino , Humanos , Sons Respiratórios , Disfunção da Prega Vocal/diagnóstico , Prega Vocal/fisiopatologia
3.
Ann Otol Rhinol Laryngol ; 129(12): 1195-1209, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32527140

RESUMO

OBJECTIVES: To explore long-term patient reported outcome (PRO) measures of pediatric paradoxical vocal cord motion (PVCM) including ease of diagnosis, management, symptom duration and effect on quality of life. METHODS: All children >8 years of age diagnosed with PVCM at a tertiary pediatric hospital between 2006 and 2017 were invited to complete a survey addressing study objectives. RESULTS: 21/47 eligible participants could be contacted and 18/21 (86%) participated. 78% were female with a mean age at diagnosis of 11.6 and 15.0 years at survey completion. Common PVCM symptoms reported were dyspnea (89%), globus sensation (56%), and stridor (50%). The median time to diagnosis was 3 months (IQR 2-5 months). Nearly all reported being misdiagnosed with another condition, usually asthma, until being correctly diagnosed usually by an otolaryngologist. Participants reported undergoing 3.7 diagnostic studies (range 0-8); pulmonary function testing was most common. Of numerous treatments acknowledged, breathing exercises were common (89%) but only reported helpful by 56%. Use of biofeedback was recalled in 1/3 of subjects but reported helpful in only 14% of them. Anti-reflux, allergy, anticholinergics, inhalers and steroids were each used in >50%, but rarely reported effective. PVCM was reportedly a significant stressor when initially diagnosed but despite 2/3 of participants still reporting ongoing PVCM symptoms, the perceived stress significantly decreased over time (Z = 3.26, P = 0.001). CONCLUSIONS: This first PVCM PRO study endorses that diagnosis is often delayed and prescribed treatments often viewed as ineffective. While biofeedback and breathing exercises may be critical for short-term control of PVCM episodes, lifestyle changes and stress reduction are likely necessary for long-term management. Increased awareness and improvements in management are needed for this condition.


Assuntos
Biorretroalimentação Psicológica , Exercícios Respiratórios , Dispneia/fisiopatologia , Sensação de Globus/fisiopatologia , Sons Respiratórios/fisiopatologia , Estresse Psicológico/psicologia , Disfunção da Prega Vocal/terapia , Adolescente , Asma/diagnóstico , Criança , Erros de Diagnóstico , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Terapia de Relaxamento , Hipersensibilidade Respiratória/diagnóstico , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/fisiopatologia , Disfunção da Prega Vocal/psicologia
4.
Rev. logop. foniatr. audiol. (Ed. impr.) ; 40(2): 48-54, abr.-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193697

RESUMO

INTRODUCCIÓN: Los cantantes son uno de los grupos de profesionales de la voz con mayor prevalencia de patología vocal y están expuestos a muchos factores de riesgo. Esto se acrecienta en el caso de los cantantes de coros amateurs que no suelen recibir nociones de técnica vocal. MÉTODO: Se estudiaron las características vocales y los factores de riesgo de 39 cantantes de coros amateur mediante el índice de incapacidad vocal abreviado (VHI-10), el índice de incapacidad vocal para el canto (S-VHI), laringoestroboscopia y análisis vocal. RESULTADOS: Los cantantes que no habían recibido clases de técnica vocal obtuvieron puntuaciones más altas tanto en el VHI-10 (10.5; p=.001) como en el S-VHI (55.9; p=.010) frente a los que sí (4 en el VHI-10 y 31.4 en el S-VHI). Respecto al sexo, encontramos que las mujeres alcanzan puntuaciones más altas (51.6) que los hombres (35) en el S-VHI (p=.019). En la muestra encontramos 9 sujetos (23.1%) con signos de fatiga vocal y 6 (15.4%) con reflujo. En el análisis acústico la frecuencia es más alta en la voz cantada (278.1HZ) que en la hablada (168.4Hz), los armónicos también son mayores en voz cantada (28dB) que en voz hablada (22dB), los valores de jitter son más altos en la voz hablada (0.24) que en la cantada (0.14) y los del shimmer también son más altos en la voz hablada (1.71) que en la cantada (1.23). CONCLUSIONES: La falta de nociones de técnica vocal en cantantes de coros amateur condiciona una mayor puntuación en los test VHI-10 y S-VHI, así como alteraciones en la laringe


INTRODUCTION: Singers are one of the groups of voice professionals with a higher incidence of vocal disorders which expose them to many risk factors. These risks are even higher in singers in amateur choirs, who usually lack vocal technique. METHOD: Vocal traits and risk factors of 39 amateur choir singers were studied using the VHI-10, the S-VHI, laryngeal examination and acoustic analysis. RESULTS: The singers who had not received lessons in vocal technique obtained higher marks in VHI-10 (10.5; P=.001) as well as in S-VHI (55.9; P=.010) compared to those who had (4 in VHI-10 and 31.4 in S-VHI). As regards sex, we find that women achieve higher marks (51.6) than men (35) in the S-VHI (P=.019). In the sample we find 9 subjects (23.1%) with evidence of vocal fatigue and 6 (15.4%) with reflux. In the acoustic analysis we observe that the frequency is higher in the singing voice (278.1HZ) than in the speaking voice (168.4Hz), the harmonics are also higher in the singing voice (28dB) than in the speaking voice (22dB), the jitter values are higher in the speaking voice (.24) than in the singing voice (.14), and shimmer values are also higher in the speaking voice (1.71) than in the singing voice (1.23). CONCLUSION: The lack of vocal technique in amateur choir singers determines a higher mark in the VHI-10 and S-VHI tests together with alterations to the larynx


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia , Distúrbios da Voz/etiologia , Distúrbios da Voz/diagnóstico , Canto/fisiologia , Inquéritos e Questionários , Fatores de Risco
5.
Respir Med ; 168: 105990, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32364960

RESUMO

BACKGROUND AND AIM: Vocal Cord Dysfunction (VCD) and chronic cough (CC) are challenging conditions which lead to significant quality of life impairment. The underlying mechanisms are poorly understood, but laryngeal dysfunction may be common to both conditions. The aim of this study was to determine the characteristics of cough in VCD and whether patients with cough have coexisting VCD. METHOD: Participants included 51 patients with VCD and a comparison group of 39 patients with chronic cough that was refractory to medical treatment. Participants underwent a comprehensive assessment including questionnaires, laryngoscopy, cough frequency monitoring and voice testing. RESULTS: Patients with VCD had significant cough morbidity with an increased cough frequency of 17.3 coughs/hour and reduced cough quality of life with mean Leicester Cough Questionnaire Score of 12.8. Breathing pattern abnormalities were also common in VCD and there was a strong correlation between the number of breathing pattern abnormalities and cough frequency (r = -0.827, p = 0.002). Cough measures were not significantly different between patients with VCD and those with CC. Moderate-severe PVFM was present in 69% of patients with CC. Abnormal vocal fold closure during phonation was also present in patients with chronic cough and was similar between the VCD (n = 40, 78.4%) and cough (n = 25, 64.1%) groups, p = 0.240. CONCLUSION: Cough is an important symptom in VCD. Patients presenting with chronic cough may have underlying VCD as a cause of their cough. Since cough and VCD symptoms co-occur clinicians need to consider cough when are treating VCD and VCD when treating chronic cough.


Assuntos
Tosse/diagnóstico , Doenças da Laringe/complicações , Disfunção da Prega Vocal/diagnóstico , Adulto , Idoso , Doença Crônica , Tosse/etiologia , Feminino , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Morbidade , Fonação , Respiração , Transtornos Respiratórios/complicações , Transtornos Respiratórios/fisiopatologia , Inquéritos e Questionários , Disfunção da Prega Vocal/etiologia , Prega Vocal/fisiopatologia
6.
Rev. logop. foniatr. audiol. (Ed. impr.) ; 39(4): 155-161, oct.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-191298

RESUMO

Introducción: Los locutores son profesionales de la voz que se caracterizan por presentar una alta exigencia vocal. El objetivo de esta investigación fue medir los cambios acústicos que podrían ser atribuidos a una rutina de calentamiento vocal sobre la calidad de la voz en locutores comerciales de radio y televisión en Chile. Material y método: Se seleccionaron 13 locutores comerciales, a quienes se le aplicó un programa de calentamiento vocal. Se midieron los parámetros de frecuencia fundamental, perturbación (jitter y shimmer), ruido, tiempo máximo de fonación y agilidad articulatoria. Todos los parámetros se midieron antes y después de la rutina de ejercicios. Por otra parte, 6 expertos fonoaudiólogos analizaron, mediante una escala visual análoga, los cambios en los espectrogramas de banda estrecha de las emisiones antes y después de la rutina de calentamiento vocal. Resultados: Se encontraron cambios significativos en la frecuencia fundamental y el tiempo máximo de fonación. En el análisis de los espectrogramas que realizaron los expertos, en 11 casos se observó mejoría entre el antes y el después de la rutina. Sumado a lo anterior, en 6 de estos casos los cambios fueron significativos. Conclusiones: El calentamiento vocal puede ser una eficaz herramienta para el cuidado de la voz en locutores comerciales


Introduction: The announcers are professionals of the voice that are characterized by presenting high vocal demand. The objective of this research was to measure the acoustic changes that could be attributed to a routine of vocal warm-up on the quality of the voice in commercial radio and television announcers in Chile. Material and method: Thirteen commercial announcers were selected and a vocal warm-up routine was applied. The parameters of fundamental frequency, jitter, shimmer, noise, maximum time of phonation and articulatory agility were measured. All parameters were measured before and after the exercise routine. On the other hand, 6 experts voice therapist analyzed through a visual analog scale changes in the narrow band spectrograms of the emissions before and after the vocal warm-up routine. Results: Significant changes were found in the fundamental frequency and maximum phonation time. In the analysis of the spectrograms performed by the experts, in 11 cases there was improvement between the before and after the routine. In addition to the above, in 6 of these cases the changes were significant. Conclusions: The vocal warm-up can be an effective tool for the care of the voice in commercial announcers


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Distúrbios da Fala/diagnóstico , Distúrbios da Voz/diagnóstico , Disfunção da Prega Vocal/diagnóstico , Temperatura Alta/efeitos adversos , Distúrbios da Fala/terapia , Distúrbios da Voz/terapia , Treinamento da Voz , Disfunção da Prega Vocal/complicações
8.
Immunol Allergy Clin North Am ; 39(4): 547-560, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563188

RESUMO

Vocal cord dysfunction (VCD) is an upper airway disorder characterized by exaggerated and transient glottic constriction causing respiratory and laryngeal symptoms. Although the origin of VCD symptoms is in the upper airway, it is frequently misdiagnosed as asthma resulting in significant morbidity. VCD can coexist with asthma or mimic allergic conditions affecting the upper airway. VCD may be difficult to diagnose, because patients are intermittently symptomatic and VCD awareness in the medical community is underappreciated. Once VCD is diagnosed and treated, most patients report significant improvement in their symptoms as well as a decrease in asthma medication use.


Assuntos
Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia , Disfunção da Prega Vocal/terapia , Asma/diagnóstico , Diagnóstico Diferencial , Gerenciamento Clínico , Suscetibilidade a Doenças , Humanos , Fenótipo , Avaliação de Sintomas
9.
Clin Sports Med ; 38(4): 563-575, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472767

RESUMO

Respiratory symptoms and infections are common among athletes. Viral upper respiratory infection symptoms may precede dyspneic symptoms seen in asthmatics or worsen symptoms of exercise-induced bronchoconstriction Knowing how to instruct an athlete on use of inhalers and having an asthma action plan are critical in management of these athletes. Other life-threatening conditions that may be seen are pneumothorax and laryngeal/pharyngeal perforation. Prompt recognition and treatment are crucial if an athlete is suspected to have pulmonary compromise. Laryngeal/pharyngeal perforations are a rare cause of issues within the training room but require a high degree of suspicion to be diagnosed and managed properly.


Assuntos
Asma/tratamento farmacológico , Broncoconstrição , Exercício Físico/fisiologia , Pneumotórax , Infecções Respiratórias , Volta ao Esporte , Asma/diagnóstico , Humanos , Laringe/lesões , Substâncias para Melhoria do Desempenho , Faringe/lesões , Pneumotórax/diagnóstico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Disfunção da Prega Vocal/diagnóstico , Ferimentos e Lesões/diagnóstico
10.
Int J Pediatr Otorhinolaryngol ; 125: 199-200, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31382107

RESUMO

We present a unique case of intermittent paradoxical vocal fold motion (PVFM) as the presenting symptom of a rare underlying neuromuscular disorder in a neonate. Paramyotonia congenita (PC) is an autosomal dominant condition that typically presents in infancy with myotonic episodes affecting the skeletal muscles. Our patient developed intermittent episodes of stridor quickly progressing to apnea shortly after birth that were marked by PVFM on laryngoscopy, ultimately leading to the diagnosis of a previously unrecognized mutation in SCN4A, the gene responsible for PC.


Assuntos
Transtornos Miotônicos/diagnóstico , Disfunção da Prega Vocal/diagnóstico , Apneia/etiologia , Feminino , Humanos , Recém-Nascido , Laringoscopia , Transtornos Miotônicos/complicações , Sons Respiratórios/etiologia , Disfunção da Prega Vocal/etiologia
11.
Pediatr Cardiol ; 40(6): 1296-1303, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31342114

RESUMO

Dysphagia and vocal cord dysfunction are frequent complications after congenital heart surgery. Both are risk factors for aspiration, which can lead to pneumonia, progressive lung disease, and respiratory arrest. A protocol was implemented to promote early detection of aspiration in a high-risk cohort of patients. Retrospective data were collected on all patients under 120 days old who underwent the Norwood procedure, aortic arch repair, Blalock-Taussig shunt placement, or cervical cannulation for extracorporeal membrane oxygenation from 10/2012 to 05/2016 at a single institution. Patients underwent an assessment of symptoms, fiberoptic endoscopic evaluation of swallowing (FEES), and modified barium swallow (MBS) study in the postoperative period prior to initiating oral feeds. Patients with and without aspiration were compared. Of the 96 patients included in the study, one-third (33%) of patients had evidence of vocal cord dysfunction by FEES and just over half (51%) had evidence of aspiration by FEES or MBS. Most (73%) of the patients with aspiration were asymptomatic and a majority (53%) of patients with aspiration had normal vocal cord function. Aspiration is common after congenital heart surgery, and an assessment of vocal cord or swallow function in isolation may lead to underdiagnosis. A comprehensive protocol including MBS and FEES is necessary for the early detection of vocal cord dysfunction and aspiration and may prevent adverse outcomes in high-risk postoperative patients.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Aspiração Respiratória/diagnóstico , Estudos de Casos e Controles , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Aspiração Respiratória/epidemiologia , Aspiração Respiratória/etiologia , Estudos Retrospectivos , Fatores de Risco , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia
13.
Respirology ; 24(8): 758-764, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30884033

RESUMO

BACKGROUND AND OBJECTIVE: Multidisciplinary team (MDT) clinics use an integrated approach to individualize care of complex medical conditions. Vocal cord dysfunction (VCD) is a challenging condition that is likely to benefit from MDT clinics but this has not been researched. METHODS: A prospective observational cohort study of a novel VCD MDT clinic was conducted in patients with suspected VCD. Relevant questionnaires, medical history, physical examination, spirometry, dynamic computerized tomography (CT) larynx and laryngoscopy were utilized and patients were allocated to treatment pathways depending on putative diagnosis. Speech pathology intervention with laryngeal retraining (LR) was offered and if LR therapy failed botulinum toxin injection was offered. Primary outcome was reductions in healthcare utilization. RESULTS: Overall, 80 consecutive patients were included in analyses. A definitive diagnosis of VCD was made in 56 of 80 (70%) patients. After LR (n = 35), emergency department (ED)/hospital admissions declined significantly in the subsequent 12 months (P = 0.001). General practice visits also reduced (P < 0.001). Botulinum toxin injections were administered in 21 patients unresponsive to LR therapy and both general practice and ED/hospital visits declined (P < 0.001 and P = 0.01, respectively) after injection. CONCLUSION: A multidisciplinary approach to VCD confers benefit and can be used to allocate appropriate management leading to a reduction in healthcare utilization.


Assuntos
Asma/diagnóstico , Equipe de Assistência ao Paciente/organização & administração , Disfunção da Prega Vocal , Austrália , Diagnóstico Diferencial , Técnicas de Diagnóstico do Sistema Respiratório , Feminino , Humanos , Colaboração Intersetorial , Masculino , Sobremedicalização/prevenção & controle , Pessoa de Meia-Idade , Otolaringologia/métodos , Otolaringologia/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia , Disfunção da Prega Vocal/terapia
14.
Eur Arch Otorhinolaryngol ; 276(4): 1109-1115, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30834974

RESUMO

PURPOSE: The clinical evaluation of vocal fold movement disorders should contain the electromyography of the laryngeal muscles (LEMG). The most challenging point in LEMG is the right positioning of the EMG needle in the small target muscles. As the results of the EMG have great influence in the decision of treatment it is important to confirm the results of this examination. Anatomical structures of the larynx should be identified with laryngeal ultrasonography and the ultrasonography (US)-guided electromagnetic needle tracking should guide the LEMG needle to the target muscle. METHODS: The thyroarytenoid (TA) and cricothyroid (CT) muscles had been evaluated in 19 patients (20 examinations). The US-guided transcutaneous LEMG using electromagnetic needle tracking was performed by one ENT doctor and all examinations had been video monitored. The videos were analyzed for the accuracy rate and the visibility of the important laryngeal structures. RESULTS: The laryngeal structures were identified in all the cases using laryngeal ultrasonography. The examination times of the US-guided LEMG were acceptable (8 min, 32 s). The US-guided LEMG was feasible in 56 (36 TA, 20 CT) examinations. The TA and CT could be visualized successfully but in 17 examinations (30%) the signal was not stable. We could still reach the target muscles in more than 50% of these cases. CONCLUSION: US-guided electromagnetic needle tracking in LEMG helps to determine the exact position of the laryngeal structures. With further technical improvement of the stability of the electromagnetic needle tracking signal the US-guided electromagnetic needle tracking of the target muscles in the larynx could help to improve the accuracy of the transcutaneous LEMG.


Assuntos
Eletromiografia/métodos , Músculos Laríngeos , Ultrassonografia de Intervenção/métodos , Disfunção da Prega Vocal/diagnóstico , Prega Vocal , Adulto , Idoso , Pontos de Referência Anatômicos , Feminino , Humanos , Músculos Laríngeos/diagnóstico por imagem , Músculos Laríngeos/fisiopatologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Prega Vocal/diagnóstico por imagem , Prega Vocal/fisiopatologia
15.
J Voice ; 33(6): 880-893, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30195411

RESUMO

INTRODUCTION: Athletes with exercise-induced laryngeal obstruction (EILO) (previously commonly referred to as paradoxical vocal fold motion disorder, or paradoxical vocal fold motion, among other terms) are often misdiagnosed, resulting in prolonged, and at times inappropriate, clinical management. The high prevalence of misdiagnosis is largely due to a lack of universal consensus of key clinical features indicating EILO and a dearth of validated quantitative approaches to accurately detect episodic laryngeal breathing disorders (ELBD) from other pathologies. Additionally, mechanisms underlying EILO clinical presentation are poorly understood, further confounding identification and management of the condition. Therefore, the objectives of this study were twofold. The first was to identify patient-centered perception of symptoms that could distinguish adolescent athletes with EILO from athletes without the condition, at baseline (rest) and during an exercise challenge (provocation), and to quantify symptom severities for use as preliminary diagnostic benchmarks. The second objective was to investigate the merit of one commonly proposed mechanism in the EILO literature-stress reactivity (temperament)-by comparing personality traits in athletes with and without EILO. METHODS: Twelve (12) athletes diagnosed with EILO and 14 healthy athletic volunteers without the condition were asked to rate the severity of their present symptoms using a 0-100 continuous visual analog scale. Participants then underwent an exercise challenge with simultaneous laryngoscopy and were asked to complete the same set of symptom severity ratings experienced during rigorous exercise. Finally, participants completed the Fear subscale on the early adolescent temperament questionnaire-revised (EATQ-R) to measure self-perceived levels of stress reactivity. RESULTS: There were significant group differences for inspiratory and expiratory dyspnea with exercise (P = 0.01). Symptoms of stridor (EILO: P = .01; control: P = .001) and throat tightness (EILO: P = .01, control: P = .01) were statistically different between rest and exercise in both groups. However, no group differences were found on these two parameters (P > .05). Other symptoms from the list of previously purported symptoms indicative of ELBD (e.g. cough, dysphonia) were infrequently reported in the exercise variant. Additionally, measurements of stress reactivity on the EATQ-R Fear subscale were similar between the two athletic groups. Interestingly, EATQ-R Fear Subscale scores for both groups were significantly higher compared to typical adolescents in the U.S. population (P < .001, respectively). DISCUSSION: Results suggest dyspnea severity, particularly when experienced during an exercise-induced ELBD (EILO) episode, is the most sensitive symptom parameter to distinguish individuals with EILO from those without the condition. These findings confirm previous literature describing episodic laryngeal breathing disorders in clinical cohorts. Results also showed symptoms of throat tightness and stridor is more prevalent during exercise, compared to rest. However, the level of their severity occurred variably across both groups of athletes and may point to a less robust indication of pathology. Finally, similarities to stress reactivity between the two athletic groups imply certain temperaments historically attributed to patients with EILO may instead better reflect temperaments in competitive young athletes, in general. CONCLUSION: Study findings highlight the importance of using normative comparisons in the study of episodic laryngeal breathing disorders to prevent overgeneralization of characteristics to clinical cohorts. Results also speak of the clinical utility of exercise challenge to improve specificity of EILO diagnosis.


Assuntos
Atletas , Dispneia/diagnóstico , Teste de Esforço , Exercício Físico , Laringoscopia , Laringoestenose/diagnóstico , Inquéritos e Questionários , Disfunção da Prega Vocal/diagnóstico , Adolescente , Estudos de Casos e Controles , Criança , Dispneia/etiologia , Dispneia/fisiopatologia , Dispneia/psicologia , Medo , Feminino , Humanos , Laringoestenose/etiologia , Laringoestenose/fisiopatologia , Laringoestenose/psicologia , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Temperamento , Disfunção da Prega Vocal/etiologia , Disfunção da Prega Vocal/fisiopatologia , Disfunção da Prega Vocal/psicologia
16.
J Pediatr Health Care ; 33(1): 5-13, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29657076

RESUMO

Vocal cord dysfunction is an obstruction of the upper airway, primarily on inspiration, due to the paradoxical adduction of the vocal cords. Vocal cord dysfunction continues to be underdiagnosed as its own entity. The lack of diagnosis can be attributed to the overlap of symptoms between asthma and exercise-induced bronchospasm. It is possible for patients diagnosed with asthma and/or exercise-induced bronchospasm to have underlying vocal cord dysfunction, which needs to be considered when prescribing asthma medications. This article will review the history of vocal cord dysfunction, the differential diagnosis, diagnostic testing, and the role of the nurse practitioner in caring for these patients.


Assuntos
Exercícios Respiratórios , Dispneia/diagnóstico , Testes de Função Respiratória/métodos , Fonoterapia , Disfunção da Prega Vocal/diagnóstico , Prega Vocal/fisiopatologia , Adolescente , Asma/diagnóstico , Asma/fisiopatologia , Criança , Diagnóstico Diferencial , Dispneia/etiologia , Dispneia/fisiopatologia , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Humanos , Laringoestenose/diagnóstico , Laringoestenose/fisiopatologia , Masculino , Pesquisa em Enfermagem , Disfunção da Prega Vocal/etiologia , Disfunção da Prega Vocal/fisiopatologia , Disfunção da Prega Vocal/terapia , Adulto Jovem
17.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 125-130, 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1010076

RESUMO

Introduction: Vocal cord dysfunction is characterized by unintentional paradoxical vocal cord movement resulting in abnormal inappropriate adduction, especially during inspiration; this predominantly manifests as unresponsive asthma or unexplained stridor. It is prudent to be well informed about the condition, since the primary presentation may mask other airway disorders. Objective: This descriptive study was intended to analyze presentations of vocal cord dysfunction in a tertiary care referral hospital. The current understanding regarding the pathophysiology and management of the condition were also explored. Methods: A total of 27 patients diagnosed with vocal cord dysfunction were analyzed based on demographic characteristics, presentations, associations and examination findings. The mechanism of causation, etiological factors implicated, diagnostic considerations and treatment options were evaluated by analysis of the current literature. Results: There was a strong female predilection noted among the study population ( n = 27), which had a mean age of 31. The most common presentations were stridor (44%) and refractory asthma (41%). Laryngopharyngeal reflux disease was the most common association in the majority (66%) of the patients, with a strong overlay of anxiety, demonstrable in 48% of the patients. Conclusion: Being aware of the condition is key to avoid misdiagnosis in vocal cord dysfunction. Fiberoptic laryngoscopy is the diagnostic gold standard to demonstrate paradoxical vocal cord adduction during an attack. A multidisciplinary approach should be adapted for the management, which should be specific and tailored for individual patients (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Prega Vocal/fisiopatologia , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/fisiopatologia , Asma , Espirometria , Diagnóstico Diferencial , Refluxo Laringofaríngeo , Disfunção da Prega Vocal/terapia , Laringoscopia
18.
Indian Pediatr ; 55(10): 905-906, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30426958

RESUMO

BACKGROUND: Intractable obstructive apneas requiring multiple intubations are rare in newborns. CASE CHARACTERISTICS: We report a pair of twins born at 29 weeks gestation who had severe obstructive apneas due to Paradoxical Vocal Cord Motion (PVCM). OUTCOME: The symptoms resolved promptly with ipratropium nebulization. Follow-up at 12 months of age revealed normal development. MESSAGE: PVCM should be considered in the differential diagnosis of intractable obstructive apneas in very low birth weight preterm infants.


Assuntos
Apneia/etiologia , Broncodilatadores/administração & dosagem , Ipratrópio/administração & dosagem , Disfunção da Prega Vocal/diagnóstico , Administração por Inalação , Apneia/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Laringoscopia/métodos , Gêmeos , Disfunção da Prega Vocal/complicações , Disfunção da Prega Vocal/tratamento farmacológico , Prega Vocal
20.
J Allergy Clin Immunol Pract ; 6(6): 2087-2095, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29729441

RESUMO

BACKGROUND: Chronic refractory cough (CRC), a phenotype of cough hypersensitivity syndrome (CHS), is a disabling problem. Laryngeal dysfunction may be important in CRC and CHS because laryngeal symptoms are common; however, the role of laryngeal dysfunction in CHS has not been systematically examined. OBJECTIVE: To determine the nature of laryngeal dysfunction in patients with CRC and compare with the related laryngeal conditions of vocal cord dysfunction (VCD) and muscle tension dysphonia (MTD). METHODS: A cross-sectional analytic design was used. We recruited 69 participants including healthy controls and patients with CRC, VCD, and MTD who were referred for behavioral speech interventions. Participants underwent a comprehensive assessment of laryngeal function during breathing, phonation, and swallowing. RESULTS: Cough frequency was high in patients with CRC (10.2 coughs/h) and VCD (16.5 coughs/h), but low in healthy controls (1.5 coughs/h) (P < .001). Patients with CRC, VCD, and MTD had impaired voice-related quality of life (vs controls, P < .05) and laryngeal hypersensitivity (vs controls, P < .05). Most voice assessment measures (3 out of 4) were significantly impaired in the CRC group compared with controls and were similar to the VCD and MTD groups. Paradoxical vocal fold movement during respiration was present in 47% of the patients with CRC at rest and in 67% after odor challenge. Mediolateral laryngeal constriction during phonation was present in 45% of the participants with CRC, 93% of the participants with VCD (P < .001 vs CC), and 64% of the participants with MTD. CONCLUSIONS: Laryngeal dysfunction is common in CRC and CHS and may contribute to CHS mechanisms. Assessment and treatment of laryngeal dysfunction using speech pathology interventions are likely to be beneficial in CHS.


Assuntos
Hipersensibilidade/diagnóstico , Laringe/patologia , Disfunção da Prega Vocal/diagnóstico , Adulto , Idoso , Austrália/epidemiologia , Tosse , Estudos Transversais , Diagnóstico Diferencial , Disfonia , Feminino , Humanos , Hipersensibilidade/epidemiologia , Masculino , Pessoa de Meia-Idade , Tono Muscular , Fonação , Respiração , Síndrome , Disfunção da Prega Vocal/epidemiologia
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