Psychogenic Respiratory Distress: A Case of Paradoxical Vocal Cord Dysfunction and Literature Review
- PMID:15014694
- PMCID:PMC181055
- DOI:10.4088/pcc.v01n0203
Psychogenic Respiratory Distress: A Case of Paradoxical Vocal Cord Dysfunction and Literature Review
Abstract
背景:肺疾病如哮喘是一种psychosomatic disorder vulnerable to exacerbations precipitated by psychological factors. A case is described in which a patient thought to have treatment-refractory asthma was discovered to have a conversion reaction, specifically paradoxical vocal cord dysfunction (PVCD), characterized by abnormal vocal cord adduction during inspiration. DATA SOURCES: Reports of PVCD were located using a MEDLINE search and review of bibliographies. MEDLINE (English language only) was searched from 1966 through December 1998 using the terms functional asthma, functional upper airway obstruction, laryngeal diseases, Munchausen's stridor, paradoxical vocal cord dysfunction, psychogenic stridor, respiratory stridor, vocal cord dysfunction, and vocal cord paralysis. A total of 170 cases of PVCD were reviewed. STUDY FINDINGS: PVCD appears to be significantly more common among females. PVCD spans all age groups, including pediatric, adolescent, and adult patients. PVCD was most often misdiagnosed as asthma or upper airway disease. Because patients present with atypical and/or refractory symptoms, several diagnostic tests are employed to evaluate patients with PVCD; laryngoscopy is the most common. Direct visualization of abnormal vocal cord movement is the most definitive means of establishing the diagnosis of PVCD. A number of psychiatric disturbances are related to PVCD, including conversion and anxiety disorders. PVCD is associated with severe psychosocial stress and difficulties with modulation of intense emotional states. CONCLUSIONS: Psychogenic respiratory distress produced by PVCD can be easily misdiagnosed as severe or refractory asthma or other pulmonary disease states. Recognition of PVCD is important to avoid unnecessary medications and invasive treatments. Primary care physicians can detect cases of PVCD by attending to clinical symptoms, implementing appropriate laboratory investigations, and examining the psychological covariates of the disorder. Psychotherapy and speech therapy are effective in treating most cases of PVCD.
Similar articles
-
Paradoxical vocal cord dysfunction in juveniles.Arch Otolaryngol Head Neck Surg. 2000 Jan;126(1):29-34. doi: 10.1001/archotol.126.1.29. Arch Otolaryngol Head Neck Surg. 2000. PMID:10628707
-
Seeing the Forest Through the Wheeze: A Case-Study Approach to Diagnosing Paradoxical Vocal-Cord Dysfunction.J Athl Train. 2002 Sep;37(3):320-324. J Athl Train. 2002. PMID:12937589 Free PMC article.
-
Hypnosis as a diagnostic modality for vocal cord dysfunction.Pediatrics. 2000 Dec;106(6):E81. doi: 10.1542/peds.106.6.e81. Pediatrics. 2000. PMID:11099624
-
之间的关系chronic cough and paradoxical vocal fold movement: a review of the literature.J Voice. 2006 Sep;20(3):466-80. doi: 10.1016/j.jvoice.2005.08.001. Epub 2005 Nov 7. J Voice. 2006. PMID:16274959 Review.
-
Paradoxical vocal cord movement during sleep - A unique case with review of literature.Int J Pediatr Otorhinolaryngol. 2015 Nov;79(11):1946-8. doi: 10.1016/j.ijporl.2015.08.019. Epub 2015 Aug 19. Int J Pediatr Otorhinolaryngol. 2015. PMID:26318024 Review.
Cited by9articles
-
Self-Reported Health in Adolescents With Exercise-Induced Laryngeal Obstruction; A Cross-Sectional Study.Front Pediatr. 2021 Jul 8;9:617759. doi: 10.3389/fped.2021.617759. eCollection 2021. Front Pediatr. 2021. PMID:34307244 Free PMC article.
-
Exercise Induced Laryngeal Obstruction in Humans and Equines. A Comparative Review.Front Physiol. 2019 Oct 30;10:1333. doi: 10.3389/fphys.2019.01333. eCollection 2019. Front Physiol. 2019. PMID:31736771 Free PMC article.
-
Vocal Cord Dysfunction: Analysis of 27 Cases and Updated Review of Pathophysiology & Management.Int Arch Otorhinolaryngol. 2019 Apr;23(2):125-130. doi: 10.1055/s-0038-1661358. Epub 2018 Oct 24. Int Arch Otorhinolaryngol. 2019. PMID:30956693 Free PMC article.
-
Asthma mimic: Case report and literature review of vocal cord nodule associated with wheezing.SAGE Open Med Case Rep. 2017 Dec 4;5:2050313X17744980. doi: 10.1177/2050313X17744980. eCollection 2017. SAGE Open Med Case Rep. 2017. PMID:29230286 Free PMC article.
-
Vocal cord dysfunction: a functional cause of respiratory distress.Breathe (Sheff). 2017 Mar;13(1):15-21. doi: 10.1183/20734735.019316. Breathe (Sheff). 2017. PMID:28289447 Free PMC article. Review.
LinkOut - more resources
Full Text Sources