Search

Abstract: Background: Vocal cord dysfunction (VCD) has been defined as adduction of the true vocal cords on inspiration with abduction on expiration. It is most common in females aged between 20 and 45 years. However, cases in children have been reported. Patients with vocal cord dysfunction present with distressing shortness of breath, inspiratory stridor and breathy dysphonia. VCD is most frequently diagnosed as asthma since the attacks in both begin and end suddenly and produce distressing breathing difficulties. Study design: Infants and children presented with respiratory distress secondary to vocal cord dysfunction were included in this study. Diagnosis of VCD depended mainly on direct laryngoscopy either using flexible laryngoscopy with topical anesthesia or direct laryngoscopy under general anesthesia with spontaneous respiration. The typical finding of adduction of the anterior two-third of the vocal cords during inspiration was the key point for diagnosis of VCD. Any further investigation was done according to the etiology of each case. Results: One infant and four children were included in this study. They were three boys and two girls. Their ages were 1, 12, 14, 10 and 2 years. The etiology of VCD was bulbar myasthenia gravis in one case, multiple system atrophy in one case, Laryngopharyngeal reflux in two cases, and post-nasal drip in one case. Diagnosis of VCD was done using pediatric flexible fibreoptic laryngoscopy with topical anesthesia in two cases and by direct laryngoscopy under general anesthesia with spontaneous respiration in three cases (in one of them the vocal cords were visualized during urgent intubation). Three cases were misdiagnosed as bronchial asthma and they were receiving treatment of asthma with no improvement. Conclusion: Vocal cord dysfunction represents a potentially overlooked differential diagnosis of recurrent dyspnea in children. It is always misdiagnosed as bronchial asthma. It should be suspected in every child with atypical or corticosteroid resistant asthma. [Copyright &y& Elsevier]

The article explores radiological approaches used to investigate the causes of a hoarse voice. The article refers to the case of a 74 year old man with a hoarse voice and difficulty swallowing. Clinical examination with laryngoscopy or flexible nasolaryngoscopy is advised to determine the underlying cause of the hoarseness. The authors explain that vocal cord paralysis or a mass lesion of the vocal cord which causes significant obstruction of the airway or is suggestive of malignancy indicates a need for imaging. Conditions which necessitate chest radiography, computed tomography or magnetic imaging (MRI) are discussed. In particular, laryngeal masses are investigated with contrast enhanced computed tomography or gadolinium enhanced MRI.

AbstractFew studies have described laryngological evaluation of patients with amyotrophic lateral sclerosis. We assessed the laryngological abnormalities of 35 such patients (24 bulbar onset and 11 limb onset). In nine limb onset patients, we discovered signs of early vagal nerve dysfunction, prior to any clinical presentation of bulbar failure. However, in all bulbar onset patients studied, we noticed changes in the uni/bilateral position of the vocal folds and in the voice quality. [ABSTRACT FROM AUTHOR]