Chest
Volume 90, Issue 5, November 1986, Pages 716-721
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Clinical Investigations
Episodic Laryngeal Dyskinesia: Clinical and Psychiatric Characterization

https://doi.org/10.1378/chest.90.5.716Get rights and content

We have obtained physiologic and psychiatric evaluations on five subjects with episodic laryngeal dyskinesia (LD) and compared them with three patients with expiratory laryngeal stridor and asthma (ELS), and five with chronic asthma (CA). Laryngoscopy confirmed adduction of the vocal cords. Diminished inspiratory flow rates with an expiratory/inspiratory ratio of 1.5 to 3.3 was demonstrated by flow volume studies. Flows improved strikingly while breathing an 80 percent helium/20 percent oxygen mixture. Patients with LD showed varying degrees of depression and sought some form of secondary gain. A histrionic personality, conversion or factitious disorders are not an essential part of this syndrome. Tracheostomy may seldom be necessary in the managing of the acute crisis of LD. Reassurance, oxygen, intermittent positive pressure, and sedation may be sufficient. Mildly depressed patients decreased the frequency and severity of wheezing episodes after receiving reassurance and a clear explanation of ventilatory mechanics.

Section snippets

Subjects

Over a ten-month period, we performed outpatient examinations of eight adult subjects with loud wheezes which appeared to originate in the neck area. The patients were identified from a pool of 1,098 new patients seen with obstructive airway disease. Seventy-three percent of these patients were referred by employers or by industrial commission and could potentially benefit from workman's compensation. The eight patients had been frequently examined in emergency rooms or admitted to hospitals

RESULTS

We studied three men and two women with episodic laryngeal dyskinesia. All were nonsmokers with a duration of symptoms ranging from three to 24 years (Table 1). Four of them had been exposed to steroid therapy during many of their very symptomatic periods. Their ages ranged from 48 to 74 years. The four who were cooperative showed no expiratory airways obstruction (Table 2). Characteristically, these patients presented to the initial and subsequent evaluations with inspiratory and expiratory

DISCUSSION

Patients with episodic laryngeal dyskinesia may be identified clinically by noting an increased tightness of the anterior neck muscles, local fremitus and a wheeze of variable pitch best heard over the anterior neck in inspiration and expiration. They are characterized physiologically by the absence of significant expiratory obstruction, diminished inspiratory flow rates, and fluttering of the inspiratory limb in flow-volume loop studies. Even in mildly symptomatic ambulatory patients,

References (0)

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Manuscript received February 10; revision accepted Mar 22.

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