Chest
Selected ReportsUse of Botulinum Toxin Type A to Avoid Tracheal Intubation or Tracheostomy in Severe Paradoxical Vocal Cord Movement
Section snippets
Case Report
A 35-year-old woman was admitted for respiratory distress after 1week of increasing dyspnea, despite treatment with inhaledcorticosteroids and bronchodilators. The patient had been treated forsuspected asthma since childhood. During the last 6 years, the patienthad experienced six similar episodes. Tracheal intubation was performedon four occasions, and tracheostomy was performed twice. During thelast episode, the respiratory obstruction resolved completelyimmediately after intubation. PVCM was
Discussion
The clinical presentation of PVCM ranges from mild dyspnea toacute respiratory distress. The condition should be considered in theacute care setting since it is frequently confused or associated withasthma.1 The case reported here provides an example ofsevere PVCM with acute hypercapnic respiratory failure.
PVCM typically disappears during sleep. In our patient, airflowlimitation resolved during acute attacks culminating in syncope orafter IV sedation. This phenomenon provides a rationale for
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Cited by (54)
Clinical Characteristics and Impact of Inducible Laryngeal Obstruction in the UK National Registry
2024, Journal of Allergy and Clinical Immunology: In PracticeInductible laryngeal obstruction
2023, Revue Francaise d'AllergologieAcute Management of Paradoxical Vocal Fold Motion (Vocal Cord Dysfunction)
2017, Annals of Emergency MedicineParadoxic vocal fold movement disorder
2014, Otolaryngologic Clinics of North AmericaVocal Cord Dysfunction
2013, Immunology and Allergy Clinics of North AmericaCitation Excerpt :A more invasive and rarely used treatment approach involves intralaryngeal injection of botulinum toxin type A. This toxin acts by preventing acetylcholine release at nerve endings, resulting in chemical denervation, which paralyzes the vocal fold in the open position.11,30,40 Although this technique has been used to successfully treat ALBD and spasmodic dystonia,11,32 a review by Morris and colleagues in 200640 found only 9 reported cases of botulinum toxin used to treat VCD.