Chest
Volume 118, Issue 3, September 2000, Pages 874-876
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Selected Reports
Use of Botulinum Toxin Type A to Avoid Tracheal Intubation or Tracheostomy in Severe Paradoxical Vocal Cord Movement

https://doi.org/10.1378/chest.118.3.874Get rights and content

Paradoxical vocal cord movement (PVCM) is characterized byparadoxical adduction of the vocal cords during inspiration and /orexpiration. Patients with severe forms of PVCM can present with acutedyspnea. In this article, we describe a patient with severe PVCM whohad required tracheal intubation or tracheostomy at multiple occasionsand who presented with acute hypercapnic respiratory failure. Usingsedation and intralaryngeal injection of botulinum toxin type A, wecould avoid more invasive intervention. Our observation shows thatbotulinum toxin type A should be considered in the acute care settingfor severe PVCM.

Section snippets

Case Report

A 35-year-old woman was admitted for respiratory distress after 1week of increasing dyspnea, despite treatment with inhaledcorticosteroids and bronchodilators. The patient had been treated forsuspected asthma since childhood. During the last 6 years, the patienthad experienced six similar episodes. Tracheal intubation was performedon four occasions, and tracheostomy was performed twice. During thelast episode, the respiratory obstruction resolved completelyimmediately after intubation. PVCM was

Discussion

The clinical presentation of PVCM ranges from mild dyspnea toacute respiratory distress. The condition should be considered in theacute care setting since it is frequently confused or associated withasthma.1 The case reported here provides an example ofsevere PVCM with acute hypercapnic respiratory failure.

PVCM typically disappears during sleep. In our patient, airflowlimitation resolved during acute attacks culminating in syncope orafter IV sedation. This phenomenon provides a rationale for

References (6)

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