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

An irritable larynx syndrome is characterized by a sudden episodic dyspnea and dysphonia that is difficult to diagnose, and patients are often treated unnecessarily and/or too much. A correct diagnosis can be made by monitoring the larynx closing in the reversed direction during inhalation and posterior chink with videolaryngoscopy and by measuring a decrease in air flow volume during inhalation with a lung function test. Patients can be effectively treated with thorough differential diagnosis. Medications targeting precipitating factors, physical therapy sessions to improve abnormal larynx movement, counseling to reduce patients'anxiety rising from dyspnea, and etc. can effectively alleviate symptoms.
Behavior Therapy ; Counseling ; Diagnosis ; Diagnosis, Differential ; Dysphonia ; Dyspnea* ; Humans ; Inhalation ; Larynx* ; Precipitating Factors ; Respiratory Function Tests ; Vocal Cord Dysfunction

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*

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*

The diagnosis of anaphylaxis is often based on reported symptoms which may not be accurate and lead to major psychosocial and financial impacts. We describe two adult patients who were diagnosed as having recurrent anaphylaxis witnessed by multiple physicians based on recurrent laryngeal symptoms. The claimed cause was foods in one and drugs in the other. We questioned the diagnosis because of absent documentation of objective findings to support anaphylaxis, and the symptoms occurred during skin testing though the test sites were not reactive. Our initial skin testing with placebos reproduced the symptoms without objective findings. Subsequent skin tests with the suspected allergens were negative yet reproduced the symptoms without objective findings. Disclosing the test results markedly displeased one patient but reassured the other who subsequently tolerated the suspected allergen. In conclusion, these 2 patients' symptoms and evaluation were not supportive of their initial diagnosis of recurrent anaphylaxis. The compatible diagnosis was Munchausen stridor which requires psychiatric evaluation and behavior modification, but often rejected by patients.
Adult ; Allergens ; Anaphylaxis* ; Behavior Therapy ; Diagnosis ; Drug Hypersensitivity ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Placebos ; Respiratory Sounds ; Skin Tests ; Vocal Cord Dysfunction

Vocal fold paralysis is an otolaryngologic disorder that is more prevalent in the adult population. Its occurrence in children has been documented in the literature. We report a case of congenital bilateral vocal fold paralysis and discuss the issues surrounding its ultimate diagnosis and management.
Human ; Female ; Child Preschool ; Vocal Cord Dysfunction ; Paralysis ; Tomography Scanners, X-Ray Computed ; Magnetic Resonance Imaging ; Electromyography ;

Vocal cord dysfunction is a recently described entity in which paradoxical adduction of the vocal cords produces airflow obstruction at the level of the larynx. Recurrent wheezing results, which may imitate asthma. Inspiratory closure of the cords can also cause stridor, commonly misdiagnosed as an upper airway obstruction of undefined cause. The acute presentation is often dramatic and has led to inappropriate treatment, including intubation, tracheotomy, or high doses of steroids. We present the case of a 9 yr old boy with allergic rhinitis who was referred to us for the evaluation of wheezing and dyspnea which did not respond to asthma management. Pulmonary function tests had abnormal inspiratory phases and laryngoscopy revealed typical adduction of the vocal cord during inspiration. Psychological tests suggested anxiety and tension with repressed aggression. There have been no further episodes, possibly due to counseling and education of relaxed throat breathing as well as avoidance of inhaled medication.
Aggression ; Airway Obstruction ; Anxiety ; Asthma ; Counseling ; Dyspnea ; Education ; Humans ; Intubation ; Laryngoscopy ; Larynx ; Male ; Pharynx ; Psychological Tests ; Respiration ; Respiratory Function Tests ; Respiratory Sounds ; Rhinitis ; Spirometry ; Steroids ; Tracheotomy ; Vocal Cord Dysfunction* ; Vocal Cords*

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*

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

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*