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Vocal cord dysfunction: an uncommon cause of stridor.

We present a case of vocal cord dysfunction syndrome (VCDS) presenting as acute angioedema of the upper airway. The presentation of this syndrome and its differentiation from other upper airway conditions that require far different and more urgent treatment is discussed.

Adult↗

Stridor and airway compromise.

A graduated approach to the diagnosis of airway lesion will rarely fail. The availability of state-of-the-art optical equipment, excellent anesthesia, and high-quality medical care have remarkably reduced the morbidity and mortality of airway diseases. Electrodiagnosis of vocal cord paralysis will differentiate fixed arytenoids from neurogenic paralysis in candidates for laryngeal repair and will help define the prognosis of neurogenic paralysis. The excellent results from epiglottoplasty in treating laryngomalacia and laryngotracheal reconstruction for stenosis make obsolete any management with tracheotomy and watchful waiting. Close cooperation and good communication between the pediatrician and the otolaryngologist remain the key points for successful management.

Airway Obstruction↗

Case report: an unusal cause of stridor in a post-liver transplant 6-year old.

Polymorphic lymphoproliferative disorder is a recognised cause of upper airway obstruction in children [N. Sculerati, M. Arriga, Ann. Otol. Rhinol. Laryngol 99 (1990) 445-450]. It is associated with long-term immunosuppression therapy and frequently with Epstein-Barr virus (EBV) infection [D.W. Hanto, Annu. Rev. Med. 46 (1995) 381-394; B.D. Fletcher, H.E. Heslop, H.C. Kaste, S. Bodner, Upper airway obstruction and pulmonary abnormalities due to lymphoproliferative disease following bone marrow transplantation in children, Pediatr. Radiol. 28 (1998) 492-496]. The prevalence in reported series ranges from 4 to 13% among post-transplant children [M. Ho, R. Jaffe, G. Miller, Transplantation 45 (1988) 719-727; G.B. Hammer, S. Cao, M.G. Boltz, A. Messner, Anesthesiology 89 (1998) 263-265; B.V. Lattyak, P. Rosenthal, Post-transplant lymphoproliferative disorder presenting in the head and neck, Laryngoscope 108 (1998) 1195-1198]. This condition may present in the transplanted allograft, the gastrointestinal tract, the head and neck, and in particular in the upper airway. Previously reported cases of upper airway obstruction have been in the supraglottis, Waldeyer's ring, the glottis, and one case of an intra tracheal mass [M. Ho, R. Jaffe, G. Miller, Transplantation 45 (1988) 719-727; G.B. Hammer, S. Cao, M.G. Boltz, A. Messner, Anesthesiology 89 (1998) 263-265]. We report a case of post-transplant lymphoproliferative disorder in the sub-glottis causing acute upper airway obstruction with negative (EBV) serology.

Acyclovir↗

Stridor.

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Adult↗