title: Repeated episodes of respiratory failure due to bilateral vocal cord paralysis.
abstract: BACKGROUND
  Bilateral vocal cord paralysis can produce severe airway obstruction, leading to acute respiratory failure. Discriminating the pathology of the upper airway from chronic obstructive diseases of the lower airways often presents a challenge for clinicians in the Emergency Department.
  
  
  OBJECTIVE
  To underlie the value of clinical examination and flow-volume loops in the establishment of diagnosis of upper airway obstruction.
  
  
  METHODS
  We describe the case of a 55-year-old female ex-smoker who presented with a long history of hoarseness and progressive exertional dyspnea. The patient developed repeated episodes of acute respiratory failure and was supported with noninvasive ventilation. The diagnosis of bilateral vocal cord paralysis was finally established by patient's symptoms and flow-volume loops demonstrating variable extrathoracic obstruction.
  
  
  CONCLUSIONS
  Vocal cord paralysis is a rare and often neglected condition, contributing to repeated episodes of acute respiratory failure. Flow-volume loop is a useful tool when symptoms are suggestive of upper airway obstruction.
authors.affiliation: Respiratory Failure Unit, General Hospital "G. Papanikolaou," Exohi, Thessaloniki, Greece.
authors.forename: Asimina
authors.initials: A
authors.lastname: Paspala
authors.forename: Evdokia
authors.initials: E
authors.lastname: Sourla
authors.forename: Afroditi
authors.initials: A
authors.lastname: Boutou
authors.forename: Fotis
authors.initials: F
authors.lastname: Zoglopitis
authors.forename: Athanasia
authors.initials: A
authors.lastname: Pataka
authors.forename: Vasilis
authors.initials: V
authors.lastname: Bagalas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Stanopoulos
authors.forename: Georgia
authors.initials: G
authors.lastname: Pitsiou
mesh_terms: D000402:Airway Obstruction / Q000209:etiology*; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D012131:Respiratory Insufficiency / Q000209:etiology*; D014139:Tracheostomy; D014826:Vocal Cord Paralysis / Q000150:complications*
keywords: flow-volume loop; noninvasive ventilation; respiratory failure; vocal cord paralysis