Vocal Cord Dysfunction

Michael Chandler, M.D.

May 2, 2006
 Disclaimer

Dr. Chandler is co-owner of MDDev,

maker of the video recording system
used to create the videos presented
 History
►A 64 year old businessman visitng from
overseas was admitted to Lenox Hill
Hospital with an acute severe exaccerbation
of asthma.
► He had been asthmatic since age 18 with a
history of polypoid sinus disease managed
medically and surgically.
► Frequent Asthma Flares
 Past History
► AllergicRhinitis and Recurrent Sinusits
► Snoring and Possible Sleep Apnea
► Severe Heartburn and Globus Sensation
► 20 Pack Year Smoking History-Quit Smoking
in Mid 1980s
► Frequent Episodes of Wheezing and Regular
Exercise Intolerance
 Hospital Course
► Treated with Solu-Medrol 60 mg IV and Xopenex
► Levaquin 500 mg
► Continued Lipitor and Allegra
► Chest X Ray-Normal
► C-T of Sinuses-Significant Sinus Disease
► Spirometry and Airway Resistance Measurements
Day 2 in Hospital
► Discharged Day 2 Much Improved
Sinus C-T Scan 11-05-04
► Prior Sinus Surgery
► Persistent Ethmoid and
Maxillary Sinusitis
 Outpatient Evaluation Day 3
► Chest Exam-Clear
► Allergy Skin Testing-Positive Only for
Aspergillus fumigatus
► Spirometry
► Rhinolaryngoscopy
► Review of Sinus C-T Scan
Rhinolaryngoscopy 11-5-04
 Summary of Findings
► Probable Mold Sensitive Sinus Disease
► Asthma
► Sinusitis
and Infected Adenoid Cyst
► Vocal Cord Edema and Paradoxical
Movement
► Wild Swings in Spirometry
► Esophageal/Laryngeal Reflux
 Treatment Plan
► 14 Day Course Levaquin
► Fluticasone Nasal Spray
► Steroids Tapered from 50 mg to 0 mg over
10 days
► Nexium 40 mg bid
► Singulair10 mg daily for Polyps and Asthma
 Follow Up 1 Year Later
► Medications-Albuterol, Advair 500 once
daily,Nexium, Lipitor, Adacand.
► No Significant Asthma Symptoms or Severe
Exaccerbations in One Year
► Exam Revealed Clear Chest
► Rhinolaryngoscopy
► Spirometry
Rhinolaryngoscopy 10-06-05
 Conclusions
Multifactorial Airways Disease
► Asthma
► Sinusitis
► Laryngeal Relux
► Mold Sensitivity
► Vocal Cord Dysfunction