Irritant-Associated Vocal Cord Dysfunction

Abstract

Vocal cord dysfunction (VCD) is a poorly understood entity that is often misdiagnosed as asthma. We report eleven cases of VCD in which there was a temporal association between VCD onset and occupational or environmental exposure. We conducted a case-control study to determine if the characteristics of irritant-exposed VCD (IVCD) cases differed from non-exposed VCD controls. Chart review of VCD patients at the authors' institution produced 11 cases that met IVCD case criteria. Thirty-three control VCD subjects were selected by age matching. There were statistical differences between the groups in ethnicity and chest discomfort. There were no statistical differences between the groups for gender, tobacco, smoking habits, symptoms, or pulmonary function parameters. Varied irritant exposures were associated with IVCD. IVCD should be considered in patients presenting with respiratory symptoms occurring after irritant exposures.

Review of the upper airway, including olfaction, as mediator of symptoms.

“…In addition to an oft-cited connection with psychological factors, there is increasing evidence that inflammatory conditions, including both rhinitis/sinusitis with chronic postnasal drip as well as gastroesophageal reflux disease (GERD), can initiate or exacerbate this condition (22). Recent work suggests that some individuals may also manifest VCD symptoms after exposure to airborne irritants as an initiating and/or triggering event (so-called irritantassociated vocal cord dysfunction) (23).…”

Occupational vocal cord dysfunction due to exposure to wood dust and xerographic toner

“…The few reported cases to date would concur with the hypothesis that vocal cord dysfunction can be caused by any nonspecific irritant in persons predisposed to develop this syndrome (9,10). Nevertheless, in the last 2 years, two case reports have been published in which the patients developed vocal cord dysfunction following exposure to a specific irritant alone (11,12).…”

“…Vocal cord dysfunction has been associated with psychiatric factors, female gender, employment in health care (5), athletic activities (6)(7)(8), and, recently, exposure to irritants at work (9). Because vocal cord dysfunction often mimics asthma, it is essential to consider this diagnosis for symptomatic patients in order to distinguish it from reactive airway dysfunction syndrome (RADS) (9).…”

“…Because vocal cord dysfunction often mimics asthma, it is essential to consider this diagnosis for symptomatic patients in order to distinguish it from reactive airway dysfunction syndrome (RADS) (9). The pathophysiology of irritant-induced vocal cord dysfunction remains unknown.…”

Vocal Cord Dysfunction after an Inhalation Exposure

“…A variety of irritant chemicals were said to induce VCD [72]. Eleven individuals manifesting voice change were initially considered to have RADS or asthma because there had been a temporal association between onset of respiratory symptom and prior occupational or environmental exposure [73]. The description of the exposures did not suggest a massive irritant gas, vapor or fume exposure essential in RADS development [74].…”