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Diagnosis of vocal cord dysfunction in asthma with high resolution dynamic volume computerized tomography of the larynx.
MedLine Citation:
PMID:  19708903     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVE: Vocal cord dysfunction (VCD) often masquerades as asthma and reports have suggested that up to 30% of patients with asthma may have coexistent VCD. Diagnosis of VCD is difficult, in part because it involves laryngoscopy which has practical constraints, and there is need for rapid non-invasive diagnosis. High speed 320-slice volume CT demonstrates laryngeal function during inspiration and expiration and may be useful in suspected VCD. METHODS: Endoscopy and high resolution 320-slice dynamic volume CT were used to examine and compare laryngeal anatomy and movement in a case of subglottic stenosis and in a patient with confirmed VCD. Nine asthmatics with ongoing symptoms and suspected VCD also underwent 320-slice dynamic volume CT. Tracheal and laryngeal anatomy and movement were evaluated and luminal areas were measured. Reductions in vocal cord luminal area >40%, lasting for >70% duration of inspiration/expiration, were judged to be consistent with VCD. RESULTS: Studies of subglottic tracheal stenosis validated anatomical similarities between endoscopy and CT images. Endoscopy and 320-slice volume CT also provided comparable dynamic images in a patient with confirmed VCD. A further nine patients with a history of severe asthma and suspected VCD were studied using CT. Four patients had evidence of VCD and the median reduction of luminal area during expiration was 78.2% (range 48.2-92.5%) compared with 10.4% (range 4.7-30%) in the five patients without VCD. Patients with VCD had no distinguishing clinical characteristics. CONCLUSIONS: Dynamic volume CT provided explicit images of the larynx, distinguished function of the vocal cords during the respiratory cycle and could identify putative VCD. The technique will potentially provide a simple, non-invasive investigation to identify laryngeal dysfunction, permitting improved management of asthma.
Authors:
Peter W Holmes; Kenneth K Lau; Marcus Crossett; Cathy Low; Douglas Buchanan; Garun S Hamilton; Philip G Bardin
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Publication Detail:
Type:  Journal Article     Date:  2009-08-25
Journal Detail:
Title:  Respirology (Carlton, Vic.)     Volume:  14     ISSN:  1440-1843     ISO Abbreviation:  Respirology     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9616368     Medline TA:  Respirology     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  1106-13     Citation Subset:  IM    
Affiliation:
Respiratory & Sleep Medicine, Diagnostic Imaging and Surgery, Monash University and Medical Centre, Melbourne, Victoria, Australia.
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