Vocal cord dysfunction syndrome – Case report with video laryngoscopy

Presentation transcript:

  • 45 years old female, a coir making worker, presented with a history of cough, choking sensations and breathlessness on exertion for 3 months.
  • Disease onset, duration and progress:
    • Episodic, severe, dry cough more during day associated with 3 episodes of cough syncope.
    • Choking sensation at the end of cough.
    • Breathlessness : MMRC Grade 1
    • non-progressive.
    • H/o retrosternal burning, mild epigastric pain present
    • No H/o rhinitis, sneezing, urticaria.
    • No H/o palpitation, orthopnea, paroxysmal nocturnal dyspnoea.
    • No H/o fever, hemoptysis
    • No H/s/o foreign body aspiration
    • No H/o joint pain, rashes, subcutaneous nodules.
    • No H/o any surgical or medical illness/ medication.
    • No H/o similar complaints in the family members.
  • On examination:
    • Afebrile, Pulse 84/min regular, RR 20/min, regular.
    • BP 120/80 mm Hg
    • Oral cavity: normal
    • Respiratory system:
      • Shape of chest: normal
      • Percussion note resonant
      • Breath sound normal and B/L equal.
    • Other systems: NAD
  • Provisional Diagnosis:
    • ? Asthma
    • ? GERDS
    • ? Vocal cord dysfunction
    • ? Acute Left ventricular dysfunction
    • ? Laryngeal edema
  • Investigations:
    • Blood R/E: TC 6500 cells/cmm, P:72, L:24, E: 4.
    • CXR: normal
    • ECG:  Normal
    • PFT: Flattening of the inspiratory limb with saw-tooth pattern
  • Fibreoptic laryngoscopy
    • Inspiratory paradoxical closing of the vocal cords with adduction of the anterior part with posterior chink  remaining open
  • Diagnosis:
    • Vocal cord dysfunction syndrome
  • Management
    • Discuss the diagnosis with the patient
    • Treat the underlined predisposing conditions such as GERDS
    • Speech Therapy
    • Treat the associated psychological disorders such as conversion disorder should be treated with counseling and Medications as required.

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