Vocal Cord Dysfunction related to Combat Deployment

Research Paper Title

Vocal Cord Dysfunction related to Combat Deployment.

Background

Several aetiologies for vocal cord dysfunction (VCD), a syndrome of dyspnea, noisy breathing, and inspiratory vocal cord closure are suggested; there is no consensus on the predisposition to its development. One previously identified psychiatric aetiology is combat stress.

Methods

A retrospective review of military personnel evaluated at Landstuhl Regional Medical Centre with a new VCD diagnosis post-deployment was conducted. Medical records were reviewed for existing pulmonary, sinus, oesophageal, or psychiatric disorders and determined their VCD evaluation.

Results

Forty-eight patients were identified with VCD symptoms after combat deployment. For military personnel with VCD, symptoms were associated with several aetiologies. 52% reported symptoms were related to high stress/anxiety, whereas 39% reported symptoms during exercise; 16% had onset with acute respiratory illness and 7% were trauma related. The combination of a truncated inspiratory flow volume loop and negative methacholine challenge had a 72% positive predictive value.

Conclusions

Common aetiologies with VCD onset during deployment are anxiety/stress, exercise, or combination of factors. Spirometry with abnormal flow volume loop plus negative methacholine challenge testing offers a reasonable predictive value for diagnosing VCD. For deployed military with these findings, laryngoscopy for upper airway disorders should be conducted.

Reference

Morris, M.J., Oleszewski, R.T., Sterner, J.B. & Allan, P.F. (2013) Vocal Cord Dysfunction related to Combat Deployment. Military Medicine. 178(11), pp.1208-1212.

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