Bilateral vocal cord palsy (BVCP) is a rare complication of thyroid surgery, and it is confusing and frustrating for both patients and medical staff. We found postoperative vocal cord dysfunction using a McGrath videolaryngoscope from a patient with stridor and dyspnea after thyroidectomy performed with intraoperative recurrent laryngeal nerve monitoring. Soon after, the patient was diagnosed with BVCP by an ENT otolaryngologist using a laryngeal fiberscope. The patient underwent exploration and received a permanent tracheostoma. The possibility of false negative findings from intraoperative nerve monitoring should considered if there is suspicion of BVCP in a high risk patient after thyroidectomy. The McGrath video-laryngoscope can be useful for early discovery of postoperative vocal cord dysfunction.
Dyspnea ; Humans ; Medical Staff ; Recurrent Laryngeal Nerve ; Respiratory Sounds ; Thyroid Gland ; Thyroidectomy* ; Vocal Cord Dysfunction ; Vocal Cord Paralysis* ; Vocal Cords*

BACKGROUND AND OBJECTIVE: Vocal cord palsy is a complex disorder which may result from numerous causes. Laryngeal electromyography is a valuable adjunct in the study of vocal cord dysfunction. It yields objective and reproducible data, and may establish the pathophysiology and prognosis of laryngeal nerve pathology. We investigated the clinical usefullness of laryngeal electromyography for patients with vocal cord palsy. MATERIAL & METHOD: Laryngeal EMG was performed for 35 patients diagnosed as vocal cord palsy. RESULTS: We defined complete denervation when electrical silence, fibrillation potential or positive sharp waves were seen. We defined partial denervation when motor unit potential with low amplitude and low frequency was seen. We planned treatment modality according to the laryngeal EMG findings. In case of complete denervation, phonosurgery was recommended, whereas voice therapy and observation were recommended when partial denervation was noted. CONCLUSION: Laryngeal EMG is clinically valuable for the evaluation of vocal cord palsy and can serve as a guideline for determining the treatment plan. It is also useful in anticipating the prognosis of laryngeal nerve palsy.
Denervation ; Electromyography* ; Humans ; Laryngeal Nerves ; Paralysis ; Pathology ; Prognosis ; Vocal Cord Dysfunction ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

Functional upper airway obstruction due to vocal cord dysfunction is being increasingly recognized and has been variously described as "Munchausen's stridor", "Emotional laryngeal wheezing", "Nervous asthma". It's features are symptoms of acute reversible recurrent dyspnea associated with an inspiratory stridor, normal anatomy of the upper airway, demonstration of variable severe exthrathoracic upper airways obstruction with pathologic adduction of the vocal cord at bronchoscopy. The patients with this condition are frequently misdiagnosed as asthma and the diagnosis is often delayed. So they can present a serious medical problem and are exposed to the complication of treatment and investigation. We report a case of functional upper airway obstruction due to vocal cord dysfunction who showed paradoxical vocal cord motion at bronchoscopy and typical features of variable exthrathoracic obstruction on Flow-volume loop during a symptomatic period.
Airway Obstruction* ; Asthma ; Bronchoscopy ; Diagnosis ; Dyspnea ; Humans ; Respiratory Sounds ; Vocal Cord Dysfunction* ; Vocal Cords*

Vocal cord dysfunction (VCD) is respiratory disorder characterized by paradoxical closure of the vocal cord during the respiratory cycle leading to obstructive airway symptoms. The clinical presentation of VCD is often dr amatic and its misdiagnosis as asthma of exercise-induced brochospasm(EIB) has led to inappropriate treatment including high dose corticosteroids, intubation, and tracheostomy. Many VCD patients are asympromatic at rest and require exercise challenge to elicit symptoms and vocal cord abnormalities. The "gold standard" for the diagnosis of VCD remains laryngoscopy of bronchoscopy with direct visualization of paradoxical adduction of the vocal cords. We report a case of exercise-induced Vocal cord masqueraded as exercise-induced asthma unresponsive to corticosteroids. And bronchodilator confirmed by typical bronchoscopic findings with paradoxial adduction of the vocal cords.
Adrenal Cortex Hormones ; Asthma* ; Asthma, Exercise-Induced ; Bronchoscopy ; Diagnosis ; Diagnostic Errors ; Humans ; Intubation ; Laryngoscopy ; Tracheostomy ; Vocal Cord Dysfunction* ; Vocal Cords*

PURPOSE: To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients. MATERIALS AND METHODS: We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed. RESULTS: A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76), and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (p<0.05). CONCLUSION: Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.
Deglutition ; Deglutition Disorders ; Endoscopes ; Fees and Charges ; Fluoroscopy ; Humans ; Phonation ; Pyriform Sinus ; Vocal Cord Dysfunction ; Vocal Cords ; Weights and Measures

Paradoxical vocal fold motion (PVFM) is a rare disorder, characterized by episodic glottic obstruction in which the vocal folds are adducted on respiration. The disorder may aggravate airway obstruction and result in respiratory failure; therefore, a proper diagnosis by the otolaryngologist is critical to subsequent treatment. A review of literature shows that the effective treatment is psychotherapy, breathing education, biofeedback, anti-reflux medications, and most importantly, botulinum toxin injection to both vocal folds. We report a case with PVFM, effectively treated with above modalities.
Airway Obstruction ; Biofeedback, Psychology ; Botulinum Toxins ; Diagnosis ; Dyspnea* ; Education ; Psychotherapy ; Respiration ; Respiratory Insufficiency ; Respiratory Sounds* ; Vocal Cord Dysfunction* ; Vocal Cords

BACKGROUND: Upper airway diseases, such as vocal cord dysfunction (VCD), masquerade as asthma. Bronchial hyperresponsiveness (BHR) to methacholine (MCh) has been demonstrated in only part of suspected asthma patients. Investigators have shown upper airway hyperresponsi- veness (UHR) in patients with VCD. OBJECTIVE: To determine the clinical importance of UHR and to evaluate the usefulness of UHR test in patients with suspected asthma. METHODS: Thirty-six consecutive patients with suspected asthma underwent a MCh inhalation challenge. BHR was determined with PC20 < 8 mg/ml, UHR with a decrease in MIF50 > 25% from the baseline, and upper airway obstruction (UAO) with MEF50/MIF50 > 1. RESULTS: Only 17 patients (47.2%) showed BHR. Also, the same proportion of subjects showed UHR, and the each combination of BHR/UHR was nearly equal in distribution (9 BHR+/UHR-, 8 BHR+/UHR+, 9 BHR-/UHR+, and 10 BHR-/UHR-). Patients with BHR-/UHR+ had significantly lower serum total IgE level than those with BHR-/UHR-. Eight patients with UHR and UAO showed significantly shorter duration of disease (p < 0.05), smaller numbers of atopy family history (p < 0.05), and lower serum total IgE level than the others (p < 0.05). CONCLUSION: Many patients with suspected asthma showed UHR, and about half of patients with negative MCh-BHR showed UHR that might be related to non-asthmatic diseases including VCD. Therefore, a routine UHR test may be warranted in detecting upper airway diseases in suspected asthma.
Airway Obstruction ; Asthma* ; Humans ; Immunoglobulin E ; Inhalation ; Methacholine Chloride* ; Research Personnel ; Vocal Cord Dysfunction

A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.
Adrenal Cortex Hormones ; Airway Obstruction* ; Asthma ; Bronchodilator Agents ; Bronchoscopy ; Dyspnea ; Extremities ; Humans ; Intubation ; Lung Diseases, Obstructive* ; Respiratory Sounds ; Tracheostomy ; Vocal Cord Dysfunction* ; Vocal Cords*

Hoarseness is a postoperative complication of thyroidectomy, mostly due to damage to the recurrent laryngeal nerve (RLN). Hoarseness may also be brought about via vocal cord dysfunction (VCD) due to injury of the vocal cords from manipulations during anesthesia, as well as from psychogenic disorders and respiratory and upper-GI related infections. The clinician or surgeon should 1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery ; 2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility 3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery 4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery ; 5) inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery ; 6) take steps to preserve the external branch of the surperior laryngeal nerve(s) when performing thyroid surgery ; 7) document whether there has been a change in voice between 2 weeks and 2 months following thyroid surgery ; 8) examine vocal fold mobility or refer the patient for examination of vocal fold mobility in patients with a change in voice following thyroid surgery ; 9) refer a patient to an otolaryngologist when abnormal vocal fold mobility is identified after thyroid surgery ; 10) counsel patients with voice change or abnormal vocal fold mobility after thyroid surgery on options for voice rehabilitation.
Anesthesia ; Dysphonia* ; Hoarseness ; Humans ; Laryngeal Nerves ; Laryngoscopy ; Postoperative Complications ; Recurrent Laryngeal Nerve ; Rehabilitation ; Thyroid Gland ; Thyroidectomy ; Vocal Cord Dysfunction ; Vocal Cords ; Voice*

Vocal cord dysfunction (VCD), a condition that frequently mimics or confounds asthma, is characterized by a paradoxical adduction of the vocal cords on inspiration. The apposition of the vocal cords produces airflow obstruction sufficient to cause wheezing, chest tightness, shortness of breath, and cough. Misdiagnosis as asthma has led to inappropriate treatment, most notably with high-dose corticosteroids. Herein we report two cases of VCD who presented with chronic cough and episodic breathlessness, respectively. Flow-volume loops on spirometry were abnormal, with evidence of variable extrathoracic airway obstruction, manifested as flat or truncated inspiratory loops. Laryngoscopy or bronchoscopy demonstrated paradoxical adduction with posterior "chinking" of the vocal cords on inspiration. One case also had asthma and depressive illness. After the diagnosis of VCD, the clinical manifestations resolved with speech therapy and/or psychotherapy. VCD should be suspected in patients with asthma-like symptoms. An early diagnosis avoids unnecessary aggressive management.
Adrenal Cortex Hormones ; Airway Obstruction ; Asthma ; Bronchoscopy ; Cough ; Diagnosis ; Diagnostic Errors ; Dyspnea ; Early Diagnosis ; Humans ; Laryngoscopy ; Psychotherapy ; Respiratory Sounds ; Speech Therapy ; Spirometry ; Thorax ; Vocal Cord Dysfunction* ; Vocal Cords*