Olin J Tod, Clary Matthew S, Connors Dan, Abbott Jordan, Brugman Susan, Deng Yiming, Chen Xiaoye, Courey Mark
Department of Pediatrics, National Jewish Health, Denver, Colorado.
Laryngoscope. 2014 Nov;124(11):2568-73. doi: 10.1002/lary.24812. Epub 2014 Jul 1.
OBJECTIVES/HYPOTHESIS: Paradoxical vocal fold motion and exercise-induced paradoxical vocal fold motion (EIPVFM) are two related conditions that do not have definitive diagnostic criteria. Much of the EIPVFM literature describes patients with characteristic physiologic findings of severe upper airway obstruction or obvious airflow limitation in the clinical context of exertional dyspnea with audible stridor. The objective of this study was to highlight a group of patients who demonstrate important clinical findings of EIPVFM (exertional dyspnea with audible stridor) without simultaneously definitive physiologic findings (mild glottic adduction and normal flow volume loops).
Retrospective medical record review.
We reviewed the records of 150 patients who performed continuous laryngoscopy during exercise for inclusion in a case series. We excluded patients for technical (incomplete records) and physiologic (extremes of disease severity) reasons. Three blinded physicians (practicing in laryngology, pulmonology, and allergy/immunology) independently evaluated isolated audio tracks, video tracks, and flow volume loops of the remaining patients for the presence or absence of stridor, the glottic configuration, and the presence or absence of inspiratory limitation on exercise flow volume loops at peak work capacity.
Exercise laryngoscopy and flow volume loops were fully evaluated for 23 patients. Five patients with exertional dyspnea were unanimously described as having audible stridor, open glottic configuration, and normal flow volume loops.
EIPVFM can occur in the absence of widely recognized confirmatory physiologic measures. Improved quantitative metrics are needed to better characterize patients with EIPVFM.
目的/假设：矛盾性声带运动及运动诱发的矛盾性声带运动（EIPVFM）是两种相关病症，目前尚无明确的诊断标准。许多关于EIPVFM的文献描述了在运动性呼吸困难伴可闻及喘鸣音的临床背景下，具有严重上气道梗阻或明显气流受限特征性生理表现的患者。本研究的目的是突出一组表现出EIPVFM重要临床特征（运动性呼吸困难伴可闻及喘鸣音）但同时又没有明确生理特征（轻度声门内收和正常流量容积环）的患者。
回顾性病历审查。
我们回顾了150例在运动期间进行连续喉镜检查的患者记录，以纳入病例系列。我们因技术原因（记录不完整）和生理原因（疾病严重程度极高或极低）排除了部分患者。三位盲法医生（从事喉科学、肺病学和过敏/免疫学）独立评估其余患者的单独音频轨道、视频轨道和流量容积环，以确定在峰值工作能力时是否存在喘鸣音、声门形态以及运动流量容积环上是否存在吸气受限。
对23例患者进行了运动喉镜检查和流量容积环的全面评估。五例运动性呼吸困难患者均被一致描述为有可闻及喘鸣音、声门开放形态以及正常流量容积环。
EIPVFM可在缺乏广泛认可的确证性生理指标的情况下发生。需要改进定量指标以更好地表征EIPVFM患者。
4级。
