Allergy and Airway |

A Case of Survivor From 25 Intubations in a Lifetime Now Getting a Diagnosis of Paradoxical Vocal Cord Movement (PVCM) FREE TO VIEW

Parth Rali, MD; Hardik Soni, MD; Win Naing, MD
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Allegheny General Hospital, Pittsburgh, PA

Chest. 2014;145(3_MeetingAbstracts):1A. doi:10.1378/chest.1822040
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SESSION TITLE: Asthma Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM


CASE PRESENTATION: 44 y/o M with history of asthma, GERD, vertigo and multiple Intubation x24times in past attributed to Peanut allergy since age 19, present with worsening shortness of breath and stridor after smelling peanut butter. In ED he was hypoxic and has stridor audible from distant. Epinephrine IM , Solumedrol, Benadryl and pepcid was given and LMA was used first w/o success so orotracheal intubation performed in ED under fiberoptic laryngoscope. No visible laryngeal edema or obstruction observed during intubation. Patient self extubated next day but again had a similar episode of stridor and difficulty in breathing and was hypoxic to high 80s. Direct laryngoscope exam showed paradoxical vocal cord movements with no airway obstruction or laryngeal edema. Patient responded well to anxiolytic avoiding an intubation. Later on support the diagnosis was tested negative for Peanut allergy and Hereditary Angioedema.

DISCUSSION: PVCM is a disease entity defined as inappropriate adduction of vocal cord during respiration. Prevalance F>M. Categorized in Primary (Psychological) and Secondary causes. Treatment is based on etiology . Treatment involves primarily behavioral changes without medication or tracheostomy. Most effective treatment would be speech therapy, stress reduction and relaxation techniques. Simple technique such as pursed lip expiration or deep inspiration through nose would also help to keep laryngeal airway open. It should be determine by laryngoscopy which method is suitable for individual to keep laryngeal airway patent. Meanwhile treatment of associated comorbid conditions such as asthma, GERD, laryngitis, neuropathies would also help to alleviate symptoms

CONCLUSIONS: The diagnosis of PVCM is often very difficult to made given episodic nature and it usually mimics severe asthma or angioedema as with our patient. Treatment needs to be individualized based and also psychiatric aspect of illness need to be addressed as well.

Reference #1: Forrest LA, Husein T, Husein O, et al. Paradoxical Vocal Cord motion: classification and treatment. Laryngoscope 2012 Apr;122(4):844-53

DISCLOSURE: The following authors have nothing to disclose: Parth Rali, Hardik Soni, Win Naing

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