Shiba Keisuke, Isono Shiroh, Nakazawa Ken
Department of Otolaryngology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba City, Chiba 260-8670, Japan.
Auris Nasus Larynx. 2007 Dec;34(4):443-52. doi: 10.1016/j.anl.2007.03.006. Epub 2007 May 4.
Paradoxical vocal cord motion (PVCM) is a well recognized respiratory condition in which active adduction of the vocal cords during inspiration causes functional airway obstruction. It is considered that laryngeal reflex acceleration underlies the generation of nonorganic PVCM. In various situations producing PVCM, multiple system atrophy (MSA) is a representative neurological disease causing nocturnal laryngeal stridor attributed to PVCM. The purpose of this review is to identify the underlying mechanisms associated with nonorganic and MSA-related PVCM. The following issues are addressed in this review: (1) the pathophysiology of nonorganic and MSA-related PVCM, (2) the relationships between PVCM and airway reflexes, and (3) the treatment for MSA-related PVCM.
Review.
An abnormality of the laryngeal output-feedback control underlies nonorganic PVCM, which is usually triggered by an excessive response to external and internal airway stimuli. Similarly, several clinical and experimental evidence suggest that MSA-related PVCM is attributed to the airway reflex as well as to paradoxical central outputs resulting from the MSA-induced damage to the pontomedullary respiratory center. Application of continuous positive airway pressure (CPAP), which suppresses the reflexive inspiratory activation of adductors, is recommended as the treatment for MSA-related PVCM.
矛盾性声带运动（PVCM）是一种公认的呼吸疾病，吸气时声带主动内收导致功能性气道阻塞。人们认为非器质性PVCM的发生机制是喉反射亢进。在各种导致PVCM的情况下，多系统萎缩（MSA）是一种典型的神经疾病，可导致因PVCM引起的夜间喉喘鸣。本综述的目的是确定与非器质性及MSA相关的PVCM相关的潜在机制。本综述探讨了以下问题：（1）非器质性及MSA相关的PVCM的病理生理学；（2）PVCM与气道反射之间的关系；（3）MSA相关的PVCM的治疗方法。
综述。
非器质性PVCM的基础是喉输出-反馈控制异常，通常由对外界和内部气道刺激的过度反应触发。同样，一些临床和实验证据表明，MSA相关的PVCM既归因于气道反射，也归因于MSA对脑桥延髓呼吸中枢造成损害导致的矛盾性中枢输出。建议应用持续气道正压通气（CPAP）治疗MSA相关的PVCM，因为CPAP可抑制内收肌的反射性吸气激活。
