Vocal Cord Dysfunction after an Inhalation Exposure

Abstract

The manuscript embodies case material and the author's extensive personal experience to address a perceived or actual airborne exposure when incorrectly judged as due to intrathoracic/lung damage when in reality the outcome is the more innocuous extrathoracic/upper airway's vocal cord dysfunction (VCD). Because of the conviction of possible lung injury, the individual applies the fetal protective glottic closure reflex to counteract an odorant cue instigating acute VCD. Breathing against an obstructed glottis as well as hyperventilation from anxiety, panic and/or fear of personal harm worsens the laryngeal spasm. Spirometer shows flattening of the inspiratory loop of the flow-volume curve and endoscopy, while not done, would reveal adduction of the anterior two-thirds of the vocal cords with posterior chinking creating a diamond shape configuration. Successful therapy and management of VCD requires a speech therapy approach rather than physician prescribed medications.

A Case of Unilateral Vocal Cord Palsy due to Bakelite Exposure

“…Lisboa et al 13 concluded that patients exposed to chemicals experienced voice and speech problems. Brooks 14 welding fumes, adhesive vapours, glutaraldehyde, ammonia and latex antigen amongst other causes. In our patient, Bakelite not only caused pulmonary manifestations as seen on CT of the thorax, but also manifested as vocal cord palsy.…”

Irritants, Irritancy and Irritant Induced Asthma

“…Vocal Cord Dysfunction after an Inhalation Exposure epitomizes acute VCD after smelling an odor or scent presumed to be a toxic exposure [3]. Perchance, VCD misconstrued after noting an actual or presumed odor occurs in a susceptible person who misdirects a stressful experience into a physical manifestation [257].…”

“…A greater number of neural signals pass between the olfactory receptors and the olfactory cortex [260]. Besides enhancement of odor perception to different odorants and innocuous stimuli, there is also voice change and marked resistance to aggressive asthma therapy [3].…”

“…In 1989, the Occupational Safety and Health Administration (OSHA), with a consensus by the American Conference of Governmental Industrial Hygienists (ACGIH), promulgate a workplace exposure limit for irritants based on objective signs of irritation [1]. The role of odors, as an indicator of a serious irritant exposure, may complicate cases of inhalational grievances [3][4][5][6][7][8]. Because of their pervasiveness, a better understanding of and preventive strategies for irritant exposures are indispensable [9,10].…”