Vocal cord dysfunction related to combat deployment.

Area of Science:

• Pulmonology
• Military Medicine
• Psychiatry

Background:

• Vocal cord dysfunction (VCD) presents with dyspnea and inspiratory stridor, but its predisposing factors remain unclear.
• Combat stress has been previously identified as a potential psychiatric etiology for VCD.

Purpose of the Study:

• To investigate the common etiologies and diagnostic approaches for VCD in military personnel post-deployment.
• To identify factors contributing to the onset of VCD in a deployed military population.

Main Methods:

• Retrospective review of military personnel diagnosed with VCD post-deployment at Landstuhl Regional Medical Center.
• Analysis of medical records for pre-existing pulmonary, sinus, esophageal, or psychiatric disorders.
• Evaluation of VCD diagnostic methods including spirometry and methacholine challenge testing.

Main Results:

• Forty-eight patients with VCD post-deployment were identified.
• Key triggers included high stress/anxiety (52%), exercise (39%), acute respiratory illness (16%), and trauma (7%).
• A combination of abnormal flow volume loop and negative methacholine challenge yielded a 72% positive predictive value for VCD.

Conclusions:

• Anxiety/stress and exercise are common etiologies for VCD onset during military deployment.
• Spirometry with an abnormal flow volume loop and negative methacholine challenge testing provide reasonable diagnostic value for VCD.
• Laryngoscopy is recommended for deployed military personnel with VCD and relevant findings to assess upper airway disorders.