Sinus computed tomography scan and markers of inflammation in vocal cord dysfunction and asthma.
BACKGROUND
The inappropriate closure of the vocal cords is characteristic of vocal cord dysfunction (VCD). These patients present with wheezing and frequently receive a misdiagnosis of asthma.


OBJECTIVE
To demonstrate the ability of computed tomography (CT) scored for the presence and extent of sinus disease and markers of inflammation to distinguish patients with VCD from patients with asthma.


METHODS
Comparisons of 13 patients with VCD were made to 77 patients presenting to the emergency room with acute asthma, 31 non-acute asthmatic patients, and 65 nonasthmatic controls. Evaluation consisted of exhaled nitric oxide gas (eNO), circulating eosinophils, and total serum immunoglobulin (Ig)E, as well as the sinus CT scan.


RESULTS
Extensive sinus CT changes were present in 23 of 74 acute asthmatic patients, 5 of 29 non-acute asthmatic patients, and 2 of 59 nonasthmatic controls. In addition, absolute eosinophil counts, eNO, and total IgE were significantly elevated among the asthmatic patients. Sinus symptoms reported by questionnaire did not predict sinus CT findings. Among the patients with VCD, none had extensive sinus disease. They also had normal eNO, low IgE, and normal eosinophil count. Five of the patients presenting to the emergency room who were identified as acute asthmatic were identified with VCD by laryngoscopy and were all characterized by the absence of significant inflammation on their sinus CT scan, low IgE, and normal eosinophil count.


CONCLUSIONS
Among patients presenting with intermittent or reversible airway obstruction, patients with VCD can be distinguished from asthma by minimum or absence of inflammation in their sinuses as shown by CT scan. Clinical symptom scores are not predictive of presence or extent of sinus disease in most cases.
Peters
Edward J
EJ
Asthma and Allergic Disease Center, Beirne Carter Center, University of Virginia, Charlottesville, Virginia, USA.
Hatley
Tina K
TK
Crater
Scott E
SE
Phillips
C Douglas
CD
Platts-Mills
Thomas A E
TA
Borish
Larry
L
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000000981:diagnostic imaging*; D015415:Biomarkers / Q000032:analysis; D003710:Demography; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000175:diagnosis; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007249:Inflammation / Q000175:diagnosis; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging; D012852:Sinusitis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014827:Vocal Cords / Q000503:physiopathology
D015415:Biomarkers; D007073:Immunoglobulin E