Use of Botulinum Toxin Type A to Avoid Tracheal Intubation or Tracheostomy in Severe Paradoxical Vocal Cord Movement

Maillard, Ivan; Schweizer, Valérie; Broccard, Alain F.; Duscher, Alexandre; Liaudet, Lucas; Schaller, M. D.

doi:10.1378/chest.118.3.874

Cited by 68 publications

(42 citation statements)

References 6 publications

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“…12 More severe cases have been treated by injection of botulinum toxin type A into the vocal cords. 13 …”

Section: Discussionmentioning

confidence: 99%

Upper airway obstruction masquerading as exercise induced bronchospasm in an elite road cyclist

Fallon

2004

Br J Sports Med

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This case concerns an elite road cyclist who complained of occasional dyspnoea and inspiratory difficulty during intense exercise. Clinical examination was normal and the final diagnosis was vocal cord dysfunction, a paradoxical closure of the vocal cords during inspiration which is highly associated with inspiratory stridor at high rates of ventilation. Awareness by the sports physician of this not uncommon condition is important to avoid misdiagnosis.

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“…12 More severe cases have been treated by injection of botulinum toxin type A into the vocal cords. 13 …”

Section: Discussionmentioning

confidence: 99%

Upper airway obstruction masquerading as exercise induced bronchospasm in an elite road cyclist

Fallon

2004

Br J Sports Med

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“…Topical lidocaine applied to the larynx may be useful during acute episodes in select patients. In severe cases, superior laryngeal blocks with Clostridium botulinum toxin have been attempted with variable success [53]. Botulinum toxin injections have been more successful for muscle tension dysphonia than for VCD.…”

Section: Management Of Vcdmentioning

confidence: 99%

Vocal cord dysfunction: what do we know?

Kenn

Balkissoon²

2010

European Respiratory Journal

145

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Vocal cord dysfunction (VCD) is a disorder caused by episodic unintentional paradoxical adduction of the vocal cords, which may induce acute severe dyspnoea attacks not responsive to conventional asthma therapy. The aetiology of VCD is complex and often multifactorial. The essential pathophysiology is that of a hyperfunctional laryngeal reflex to protect the lower airway as a result of any combination of post-nasal drip, gastro-oesophageal reflux, laryngopharyngeal reflux and/or psychological conditions. Laryngoscopic demonstration of the paradoxical motion while wheezing or stridorous is considered the diagnostic gold standard. Speech therapy, including the use of special relaxed-throat breathing patterns is effective for VCD that is purely of the functional nature. Knowledge of the clinical features of VCD and identifying factors that may be contributing to the development of VCD can provide adequate clues to the correct diagnosis and management.

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“…Other ways patients can control symptoms is with general vocal hygiene and identifying an eliminating individual triggers. Cases of severe PVFMD that cannot be controlled with LCT, the use of benzodiazepines, heliox, or laryngeal botox have shown benefit [76][77][78].…”

Section: Treatmentmentioning

confidence: 99%

Dyspneic athlete

Krey

Best

2014

Curr Rev Musculoskelet Med

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Breathing concerns in athletes are common and can be due to a wide variety of pathology. The most common etiologies are exercise-induced bronchoconstriction (EIB) and paradoxic vocal fold movement disorder (PVFMD). Although some patients may have both, PVFMD is often misdiagnosed as EIB, which can lead to unnecessary treatment. The history and physical exam are important to rule out life threatening pulmonary and cardiac causes as well as common conditions such as gastroesophageal reflux disease, sinusitis, and allergic etiologies. The history and physical exam have been shown to be not as vital in diagnosing EIB and PVFMD. Improvement in diagnostic testing with office base spirometry, bronchoprovocation testing, eucapnic voluntary hyperpnea (EVH) and video laryngoscopy are essential in properly diagnosing these conditions. Accurate diagnosis leads to proper management, which is essential to avoid unnecessary testing and save healthcare costs. Also important to the physician treating dyspnea in athletes is knowing regulations on medications, drug testing, and proper documentation needed for certain organizations. The differential diagnosis of dyspnea is broad and is not limited to EIB and PVFMD. Ruling out life threatening cardiac and pulmonary causes with a proper history, physical, and appropriate testing is essential. The purpose of this review is to highlight recent literature on the diagnosis and management of EIB and PVFMD as well as discuss other potential causes for dyspnea in the athlete.

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Use of Botulinum Toxin Type A to Avoid Tracheal Intubation or Tracheostomy in Severe Paradoxical Vocal Cord Movement

Cited by 68 publications

References 6 publications

Upper airway obstruction masquerading as exercise induced bronchospasm in an elite road cyclist

Upper airway obstruction masquerading as exercise induced bronchospasm in an elite road cyclist

Vocal cord dysfunction: what do we know?

Dyspneic athlete

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