Upper airways obstruction with bilateral vocal cord paralysis.

Area of Science:

• Pulmonology
• Otolaryngology
• Respiratory Physiology

Background:

• Bilateral vocal cord paralysis presents a significant clinical challenge.
• Understanding the pattern of extrathoracic airway obstruction is crucial for patient management.

Purpose of the Study:

• To investigate the characteristics of extrathoracic airway obstruction in patients with bilateral vocal cord paralysis.
• To analyze the variability of airflow dynamics, particularly inspiratory flow, in this patient cohort.

Main Methods:

• Utilized spirometry and flow-volume loops to assess airflow.
• Measured the ratio of forced expiratory flow at 50% vital capacity to forced inspiratory flow at the same lung volume (VE50/VI50).
• Monitored patients with bilateral vocal cord paralysis.

Main Results:

• Demonstrated variable extrathoracic airway obstruction in ten patients.
• Observed a mean VE50/VI50 ratio of 1.65 +/- 0.77.
• Found marked variability in inspiratory flow obstruction, with a mean VI50 of 1.63 +/- 0.75 L/sec and a wide range (0.9-3.2 L/sec).

Conclusions:

• Bilateral vocal cord paralysis is associated with unpredictable extrathoracic airway obstruction.
• Significant inspiratory flow limitation is a key finding.
• Nine out of ten patients required tracheostomy due to dyspnea, highlighting the severity of airway compromise.