Vocal cord dysfunction in former World Trade Center (WTC) rescue and recovery workers and volunteers.
BACKGROUND
Vocal cord dysfunction (VCD) is a condition characterized by paradoxical partial adduction of the vocal cords on inspiration. It has been associated with exposures to irritants, as well as with psychological illnesses and conditions. Workers who participated in the recovery of the WTC disaster site were exposed to a large amount of irritants as well as considerable psychological stressors. We describe the clinical characteristics of 10 symptomatic former WTC workers diagnosed with this condition, as well as the frequency of spirometric findings suggestive of variable extrathoracic obstruction.


METHODS
Workers who became symptomatic after their WTC work experience have been evaluated clinically by a multidisciplinary team at an academic medical center. The evaluation included history, physical examination, chest radiograph, blood tests, and pre- and post-bronchodilator spirometry in all patients. Additional evaluations and diagnostic tests included otolaryngological evaluation with flexible rhinolaryngoscopy and stroboscopy, gastroenterological and psychiatric evaluations. A randomly selected sample of 172 spirometry results were reviewed for evidence of inspiratory flow limitation.


RESULTS
Variable extrathoracic obstruction was found in 18.6% of the spirometries. Ten patients were diagnosed with VCD. In addition to symptoms suggestive of co-morbid conditions (particularly rhinitis and acid reflux disease), most of the 10 patients had (1) hoarseness, (2) dyspnea that was not associated with bronchial hyperreactivity, or (3) dyspnea associated with asthma, with either mild bronchial hyperreactivity and/or poor response to asthma treatment.


CONCLUSIONS
VCD appears to be part of the spectrum of airway disorders caused by occupational exposures at the WTC disaster site. Further study of this association is warranted.
de la Hoz
Rafael E
RE
Department of Community and Preventive Medicine, and Medicine, The Mount Sinai School of Medicine, New York, New York, USA. rafael.delahoz@mssm.edu
Shohet
Michael R
MR
Bienenfeld
Laura A
LA
Afilaka
Aboaba A
AA
Levin
Stephen M
SM
Herbert
Robin
R
D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001249:Asthma; D015897:Comorbidity; D004417:Dyspnea; D005260:Female; D006685:Hoarseness / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D018635:Rescue Work; D047851:September 11 Terrorist Attacks / Q000523:psychology; D013147:Spirometry; D014827:Vocal Cords / Q000503:physiopathology*; D014832:Voice Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014838:Volunteers / Q000523:psychology