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Related Experiment Videos

The flow-volume loop in bilateral vocal cord paralysis

C T Bolliger1, J Sopko, P Maurer

  • 1Department of Internal Medicine, University Hospital, Basel, Switzerland.

Chest
|October 1, 1993
PubMed
Summary

This study identifies key spirometry findings suggestive of variable upper airway obstruction caused by bilateral vocal cord paralysis. These findings help differentiate vocal cord issues from tracheal lesions in patients with breathing difficulties.

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Area of Science:

  • Pulmonology
  • Otolaryngology
  • Medical Diagnostics

Background:

  • Post-traumatic airway compromise can lead to complex respiratory issues.
  • Bilateral vocal cord paralysis and tracheal avulsion present diagnostic challenges.
  • Accurate differentiation between laryngeal and tracheal obstruction is crucial for effective management.

Observation:

  • A patient with a history of vocal cord paralysis and tracheal repair reported exertional dyspnea.
  • Spirometry revealed characteristic findings of variable upper airway obstruction (UAO).
  • Endoscopy demonstrated inspiratory laryngeal obstruction due to paradoxical vocal cord movement.

Findings:

  • A forced expiratory volume in 1 second (FEV1)/peak expiratory flow (PEF) ratio > 10 ml/L/min suggests variable UAO.

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  • A maximal expiratory flow at 50% of FVC (MEF50)/maximal inspiratory flow at 50% of FVC (MIF50) ratio > 4 supports this diagnosis.
  • These combined spirometry metrics are indicative of bilateral vocal cord paralysis over tracheal pathology.

    • Implications:

    • Spirometry, specifically FEV1/PEF and MEF50/MIF50 ratios, can aid in diagnosing the cause of extrathoracic airway obstruction.
    • This non-invasive method assists in distinguishing vocal cord paralysis from tracheal lesions.
    • Improved diagnostic accuracy can lead to more targeted and effective therapeutic interventions for airway obstruction.