Use of videography in the diagnosis of exercise-induced vocal cord dysfunction: A case report with video clips

Davis, Ray S.; Brugman, Susan M.; Larsen, Gary L.

doi:10.1016/j.jaci.2007.04.007

Cited by 20 publications

(7 citation statements)

References 10 publications

(22 reference statements)

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“…It is often mandatory to observe closely the actual event and performance to get the idea, what is wrong with the athlete. For example, in the diagnosis of exercise‐induced vocal cord dysfunction, video clips during an attack in the field have proved to be useful in some cases of elite athletes (55).…”

Section: Use Several Measures To Get It Rightsupporting

confidence: 89%

Mechanisms of asthma in Olympic athletes – practical implications

Haahtela

Malmberg

Moreira

2008

Allergy

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Athletes’ symptoms may only occur in extreme conditions, which are far from normal. Exercise may increase ventilation up to 200 l/min for short periods in speed and power athletes, and for longer periods in endurance athletes such as swimmers and cross‐country skiers. Increasing proportions of young athletes are atopic, i.e. they show signs of IgE‐mediated allergy which is, along with the sport event (endurance sport), a major risk factor for asthma and respiratory symptoms. Mechanisms in the etiology and clinical phenotypes vary between disciplines and individuals, and it may be an oversimplification to discuss athlete’s asthma as a distinct and unambiguous disease. Nevertheless, the experience on Finnish Olympic athletes suggests at least two different clinical phenotypes, which may reflect different underlying mechanisms. The pattern of ‘classical asthma’ is characterized by early onset childhood asthma, methacholine responsiveness, atopy and signs of eosinophilic airway inflammation, reflected by increased exhaled nitric oxide levels. Another distinct phenotype includes late onset symptoms (during sports career), bronchial responsiveness to eucapnic hyperventilation test, but not necessarily to inhaled methacholine, and a variable association with atopic markers and nitric oxide. A mixed type of eosinophilic and neutrophilic airway inflammation seems to affect especially swimmers, ice‐hockey players, and cross‐country skiers. The inflammation may represent a multifactorial trauma, in which both allergic and irritant mechanisms play a role. There is a significant problem of both under‐ and overdiagnosing asthma in athletes and the need for objective testing is emphasized. Follow‐up studies are needed to assess the temporal relationship between asthma and competitive sporting, taking better into account individual disposition, environmental factors (exposure), intensity of training and potential confounders.

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Section: Use Several Measures To Get It Rightsupporting

confidence: 89%

Mechanisms of asthma in Olympic athletes – practical implications

Haahtela

Malmberg

Moreira

2008

Allergy

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“…Although larger studies are warranted, the findings presented in this report are consistent with the conclusion that IOS may provide a non-invasive approach to the diagnosis of VCD. 34 …”

Section: Discussionmentioning

confidence: 99%

Vocal Cord Dysfunction as Demonstrated by Impulse Oscillometry

Komarow

Young

Nelson

et al. 2013

The Journal of Allergy and Clinical Immunology: In Practice

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Background Vocal cord dysfunction (VCD) is a respiratory disorder characterized by inappropriate vocal cord adduction during inspiration. The diagnosis of VCD is challenging, as expected flow volume loop abnormalities are uncommonly noted and laryngoscopy must be timed to coincide with symptoms. Objective To determine the potential role of Impulse Oscillometry (IOS) in the diagnosis of VCD. Methods: We conducted an analysis of 6 patients in which the diagnosis of VCD was being considered as well as 7 normal subjects and five subjects with asthma. All were evaluated with IOS, spirometry and patients underwent laryngoscopy. Two patients with suspected VCD who did not exhibit symptoms or abnormal pulmonary function at baseline underwent exercise challenge and repeat studies. One patient with suspected VCD underwent an additional irritant challenge. Results VCD was diagnosed by laryngoscopy in 3 of the 6 patients where the diagnosis of VCD was entertained. These three patients as a group all exhibited higher amplitude (mean, 9.3 cm H20/L/sec) and more variable spikes (SD, 4.8) on IOS impedance during inspiration, while the 3 patients where the diagnosis was not confirmed by endoscopy did not show these findings (mean, 2.0, P<0.0002; SD, 0.8, P<0.0001). This pattern was also not observed in the normal volunteers (mean, 1.8; SD, 0.7) and asthmatics at baseline (mean, 4.2; SD, 1.2) or following exercise challenge (mean, 1.5; SD, 0.5). Conclusions These findings support the conclusion that IOS displays a characteristic pattern in patients with VCD and thus may offer a rapid and non-invasive adjunct to the assessment and diagnosis of patients suspected to have this disorder.

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“…The confirmation of VCD requires direct or indirect visualization of paradoxical laryngeal motion during symptoms. 1,3,4 Because VCD symptoms are episodic, performing a laryngoscopy in an asymptomatic patient is usually not sufficient to document paradoxical motion. Consequently, many clinicians diagnose VCD provisionally without visualizing the larynx, choosing instead to proceed with empiric treatment that typically involves a consultation with a speech pathologist for laryngeal relaxation training.…”

Section: To the Editormentioning

confidence: 99%