Tags

Type your tag names separated by a space and hit enter

Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test.
J Voice. 2017 Mar; 31(2):247.e19-247.e23.JV

Abstract

OBJECTIVES

Timely diagnosis of vocal cord dysfunction (VCD), more recently termed "inducible laryngeal obstruction," is important because VCD is often misdiagnosed as asthma, resulting in delayed diagnosis and inappropriate treatment. Visualization of paradoxical vocal cord movement on laryngoscopy is the gold standard for diagnosis, but is limited by poor test sensitivity. Provocation tests may improve the diagnosis of VCD, but the diagnostic performance of current tests is less than ideal. Alternative provocation tests are required. This pilot study demonstrates the feasibility of using inhaled mannitol for concurrent investigation of laryngeal and bronchial hyperresponsiveness.

METHODS

Consecutive patients with suspected VCD seen at our institution's asthma clinic underwent flexible laryngoscopy at baseline and following mannitol challenge. VCD was diagnosed on laryngoscopy based on inspiratory adduction, or >50% expiratory adduction of the vocal cords. Bronchial hyperresponsiveness after mannitol challenge was also assessed. We evaluated the interrater agreement of postmannitol laryngoscopy between respiratory specialists and laryngologists.

RESULTS

Fourteen patients with suspected VCD in the context of asthma evaluation were included in the study. Mannitol provocation demonstrated VCD in three of the seven patients with normal baseline laryngoscopy (42.9%). Only two patients had bronchial hyperresponsiveness. There was substantial interrater agreement between respiratory specialists and laryngologists, kappa = 0.696 (95% confidence interval: 0.324-1) (P = 0.006).

CONCLUSION

Inhaled mannitol can be used to induce VCD. It is well tolerated and can evaluate laryngeal and bronchial hyperresponsiveness at the same setting.

Authors+Show Affiliations

Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: tunn_ren_tay@cgh.com.sg.Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.Department of Otolaryngology, Head and Neck Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.Department of Otolaryngology, Head and Neck Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27567392

Citation

Tay, Tunn Ren, et al. "Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test." Journal of Voice : Official Journal of the Voice Foundation, vol. 31, no. 2, 2017, pp. 247.e19-247.e23.
Tay TR, Hoy R, Richards AL, et al. Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test. J Voice. 2017;31(2):247.e19-247.e23.
Tay, T. R., Hoy, R., Richards, A. L., Paddle, P., & Hew, M. (2017). Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test. Journal of Voice : Official Journal of the Voice Foundation, 31(2), e19-e23. https://doi.org/10.1016/j.jvoice.2016.08.003
Tay TR, et al. Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test. J Voice. 2017;31(2):247.e19-247.e23. PubMed PMID: 27567392.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test. AU - Tay,Tunn Ren, AU - Hoy,Ryan, AU - Richards,Amanda L, AU - Paddle,Paul, AU - Hew,Mark, Y1 - 2016/08/25/ PY - 2016/06/25/received PY - 2016/08/02/revised PY - 2016/08/04/accepted PY - 2016/8/28/pubmed PY - 2017/9/26/medline PY - 2016/8/28/entrez KW - Asthma KW - Larynx KW - Mannitol KW - Paradoxical vocal fold motion KW - Vocal cord dysfunction SP - 247.e19 EP - 247.e23 JF - Journal of voice : official journal of the Voice Foundation JO - J Voice VL - 31 IS - 2 N2 - OBJECTIVES: Timely diagnosis of vocal cord dysfunction (VCD), more recently termed "inducible laryngeal obstruction," is important because VCD is often misdiagnosed as asthma, resulting in delayed diagnosis and inappropriate treatment. Visualization of paradoxical vocal cord movement on laryngoscopy is the gold standard for diagnosis, but is limited by poor test sensitivity. Provocation tests may improve the diagnosis of VCD, but the diagnostic performance of current tests is less than ideal. Alternative provocation tests are required. This pilot study demonstrates the feasibility of using inhaled mannitol for concurrent investigation of laryngeal and bronchial hyperresponsiveness. METHODS: Consecutive patients with suspected VCD seen at our institution's asthma clinic underwent flexible laryngoscopy at baseline and following mannitol challenge. VCD was diagnosed on laryngoscopy based on inspiratory adduction, or >50% expiratory adduction of the vocal cords. Bronchial hyperresponsiveness after mannitol challenge was also assessed. We evaluated the interrater agreement of postmannitol laryngoscopy between respiratory specialists and laryngologists. RESULTS: Fourteen patients with suspected VCD in the context of asthma evaluation were included in the study. Mannitol provocation demonstrated VCD in three of the seven patients with normal baseline laryngoscopy (42.9%). Only two patients had bronchial hyperresponsiveness. There was substantial interrater agreement between respiratory specialists and laryngologists, kappa = 0.696 (95% confidence interval: 0.324-1) (P = 0.006). CONCLUSION: Inhaled mannitol can be used to induce VCD. It is well tolerated and can evaluate laryngeal and bronchial hyperresponsiveness at the same setting. SN - 1873-4588 UR - https://www.unboundmedicine.com/medline/citation/27567392/Inhaled_Mannitol_as_a_Laryngeal_and_Bronchial_Provocation_Test_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0892-1997(16)30247-8 DB - PRIME DP - Unbound Medicine ER -