PARADOXICAL T V C D. ANTONIO (T) YSUNZA M.D. Ph.D. BEAUMONT ROYAL OAK
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1 PARADOXICAL T V C D ANTONIO (T) YSUNZA M.D. Ph.D. BEAUMONT ROYAL OAK
2 GOALS P T V C D: WHAT IS IT? DIAGNOSIS DIFFERENTIAL DIAGNOSIS PATHOPHYSIOLOGY TREATMENT ACUTE TREATMENT LONG TERM
3 MUNCHAUSEN STRIDOR Really factitious?? Munchausen Syndrome in DSM-5 = Factitious Disorder
4 Factitious Disorder (DSM-5) A person with a factitious disorder intentionally produces, feigns or exaggerates the symptoms of a disease, illness or psychological condition with the aim of assuming the patient role. The motive varies but may include a desire to seek comfort and attention, attempt to gain access to drugs, or a fascination with the medical field. The sufferer may have a personality disorder and/or unresolved issues from childhood, such as physical or emotional abuse, or early detachment. These motives differ from those of malingering in which one fakes symptoms to gain disability payments or medical leave.
5 PARADOXICAL TRUE VOCAL CORD DYSFUNCTION NOT A FACTITIOUS DISORDER!!
6 P T V C D TRUE OR FICTION?? > 40 NAMES HAVE BEEN USED : MUNCHAUSSEN STRIDOR EMOTIONAL LARYNGEAL WHEEZING EPISODIC LARYNGEAL DYSKINESIA EPISODIC PAROXYSMAL LARYNGOSPASM
7 P T V C D FACTITIOUS ASTHMA FUNCTIONAL LARYNGEAL OBSTRUCTION FUNCTIONAL LARYNGEAL STRIDOR FUNCTIONAL UPPER AIRWAY OBSTRUCTION IRRITABLE LARYNX SYNDROME
8 P T V C D LARYNGEAL DYSKINESIA NONORGANIC UPPER AIRWAY OBSTRUCTION PARADOXICAL VOCAL CORD MOTION PERIODIC OCCURRENCE OF LARYNGEAL OBSTRUCTION PSEUDOASTHMA
9 P T V C D PSYCHOGENIC UPPER AIRWAY OBSTRUCTION SPASMODIC CROUP EXERCISE INDUCED LARYNGOSPASM VOCAL CORD DYSFUNCTION PARADOXICAL TRUE VOCAL CORD DYSFUNCTION
10 P T V C D P T V C D OR V C D FIRST USED IN N ENG J MED (1983) BY CHRISTOPHER ET AL.
11 P T V C D GOLD STANDARD DIAGNOSTIC MARKER : VIDEOLARYNGOSCOPY B U T...
12 P T V C D Dx M A R K E R (+) (-) (+) (-) a b c d
13 P T V C D Dx M A R K E R (+) (-) (+) (-) a b c d TRUE POSITIVES
14 P T V C D Dx M A R K E R (+) (-) (+) (-) a b c d TRUE NEGATIVES
15 P T V C D Dx M A R K E R (+) (-) (+) (-) a b c d FALSE NEGATIVES
16 P T V C D Dx M A R K E R (+) (-) (+) (-) a b c d FALSE POSITIVES
17 SENSITIVITY a / a + c ****FALSE POS. NOT COSIDERED Dx. MARKER WITH HIGH SENSITIVITY IS MOST USEFUL WHEN NEGATIVE (DETECTION OR SCREENING)
18 SPECIFICITY d / b + d ****FALSE NEG. NOT COSIDERED Dx. MARKER WITH HIGH SPECIFICITY IS MOST USEFUL WHEN POSITIVE (CONFIRMATION)
19 EXAMPLES HIGH SENSITIVITY = ELISA (DETECT HIV POS.) HIGH SPECIFICITY = WESTERN BLOT (HIV); E E G ; ENDOSCOPY FOR P T V C D (BEST DX. MARKER BUT NOT G S
20 DX. P T V C D ENDOSCOPY = HIGHLY SPECIFIC BUT POOR SENSITIVITY USEFUL ONLY WHEN ( + )
21 P T V C D DIAGNOSTIC MARKER FOR INCREASING SENSITIVITY: EXERCISE INDUCED FLEXIBLE V N P > 50 % TVC ADDUCTION DURING INSPIRATION WITH STRIDOR TREADMILL
22 DIFF. DX. P T V C D ASTHMA ANGIOEDEMA AERODIGESTIVE FOREIGN BODY LARYNGEAL / PROXIMAL TRACHEA MASS
23 DIFF. DX. P T V C D BILATERAL V C PARESIS TRACHEAL / SUBGLOTTIC STENOSIS CROUP EPIGLOTTITIS / SUPRAGLOTTITIS
24 P T V C D STRIDOR VS WHEEZING P T V C D ONLY W STRIDOR ONLY DURING INSPIRATION SUSCEPTIBLE INDIV. DYSF. BREATHING REFLEXES. RECURRING CYCLE ANXIETY ACT. LAR.
25 Laryngeal hyperresponsiveness: 1.Sinus disease 2.Reflux/inhales irritants Other factors: 1.Reduced Forced exp vol 2.High BMI 3.Anxiety Depression 4.Female gender
26 PTVCD ACUTE MANAGEMENT HELIOX (OXYGEN + HELIUM) NON-INVASIVE POSITIVE PRESSURE KETAMINE
27 PTVCD ACUTE MANAGEMENT HELIOX = DECREASE RESISTANCE TO GAS FLOW WITHIN AIRWAY IMPROVING VENTILATION HELIOX (CYLINDER) = 79 % HELIUM; 21 % OXYGEN
28 PTVCD LONG TERM MANAGEMENT PRIMARY THERAPY : SLP FA PHONIATRIST OTHER OPTION: BOTOX
29 PTVCD LONG TERM MANAGEMENT DETAILED HISTORY EXPLAIN STRIDOR AND WHEEZING EXPLAIN T V C FUNCTION AND DYSFUNCTION EXPLAIN PTVCD
30 PTVCD LONG TERM MANAGEMENT IDENTIFY TRIGGERS SNIFF EXHALE TECHNIQUE DIAPHRAGMATIC BREATHING PATTERN
31 PTVCD LONG TERM MANAGEMENT REFLEXIVELY CONTROLLED LARYNGEAL MOTOR PATTERNS: SNIFF COUGH
32 PTVCD LONG TERM MANAGEMENT SNIFF: T V C ABDUCTION SIMULTANEOUS CONTRACTION OF ANTAGONISTS
33 PTVCD LONG TERM MANAGEMENT EXHALE: NOT BLOWING PURSUED LIPS USE A STRAW
34 PTVCD LONG TERM MANAGEMENT REDUCE ANXIETY COUNSELING
35 PTVCD LONG TERM MANAGEMENT IJPORL (2012): 1 4 TREATMENT VISITS. MEAN = 1.3 VISITS 86% = ONLY ONE VISIT ASSOC. W ASTHMA = 68%
36 PTVCD LONG TERM OUR NUMBERS: MANAGEMENT 2017 = 45 PATIENTS W DX OF TVCD 2 PATIENTS = NO TVCD TREATMENT VISITS: 1 3 VISITS 93 % ONLY ONE VISIT ASSOC W ASTHMA = 80 %
37 GRACIAS POR SU ATENCION!! ADDITIONAL INFORMATION REFERENCES COMMENTS DONATIONS GIFTS
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