title: Vocal cord dysfunction related to combat deployment.
abstract: OBJECTIVE
  Several etiologies for vocal cord dysfunction (VCD), a syndrome of dyspnea, noisy breathing, and inspiratory vocal cord closure are suggested; there is no consensus on the predisposition to its development. One previously identified psychiatric etiology is combat stress.
  
  
  METHODS
  A retrospective review of military personnel evaluated at Landstuhl Regional Medical Center with a new VCD diagnosis post-deployment was conducted. Medical records were reviewed for existing pulmonary, sinus, esophageal, or psychiatric disorders and determined their VCD evaluation.
  
  
  RESULTS
  Forty-eight patients were identified with VCD symptoms after combat deployment. For military personnel with VCD, symptoms were associated with several etiologies. Fifty-two percent reported symptoms were related to high stress/anxiety, whereas 39% reported symptoms during exercise; 16% had onset with acute respiratory illness and 7% were trauma related. The combination of a truncated inspiratory flow volume loop and negative methacholine challenge had a 72% positive predictive value.
  
  
  CONCLUSIONS
  Common etiologies with VCD onset during deployment are anxiety/stress, exercise, or combination of factors. Spirometry with abnormal flow volume loop plus negative methacholine challenge testing offers a reasonable predictive value for diagnosing VCD. For deployed military with these findings, laryngoscopy for upper airway disorders should be conducted.
authors.affiliation: Pulmonary/Critical Care Service, Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Morris
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Oleszewski
authors.forename: James B
authors.initials: JB
authors.lastname: Sterner
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Allan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013147:Spirometry; D013315:Stress, Psychological / Q000150:complications*; D064706:Vocal Cord Dysfunction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology