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Fiberoptic Laryngeal Examination:
A fiberoptic laryngeal examination is crucial in making a PVCD diagnosis.
What is a fiberoptic laryngeal examination?
It is an examination of the larynx that uses a fiberscope that passes
through the nasal cavity. This examination allows you to view the
vocal folds, the supraglottal structures, and even the velopharyngeal
mechanism (Colton & Casper, 1996).
During the fiberoptic laryngeal examination the patient should be asked to
* Alternatively phonate the vowel /i/ and sniff,
in rapid alternating succession.
* Take deep breaths
* Cough, clear their throat, and chuckle
* Count to fifty, rapidly and loudly
* Read a passage in a loud voice
* Sing
In some instances a vocal cord attack may be induced in order to get a clear diagnosis of paradoxical vocal cord dysfunction. Attacks can be induced by implementing a standard 10-minute, graded treadmill or bicycle exercise used to produce an asthma attack.
These tasks should reveal a pattern of adduction and abduction consistent with paradoxical vocal cord dysfunction. Some of these patterns include:
* Inappropriate vocal fold adduction during
inspiration
* Paroxysmal inability to abduct the vocal cords
* Or a combination of the first two
Patients with organic causes of paradoxical vocal cord dysfunction usually demonstrate consistent fiberoptic findings, whereas patients with psychogenic paradoxical vocal cord dysfunction do not. For example patients with psychogenic stridor will often revert to normal phasic vocal cord movement when asked to count or read (Koufman, 1994).
WHAT IS PVCD? POPULATION AFFECTED ETIOLOGIES