FUNCTIONAL LARYNGEAL DYSKINESIA IN CHILDREN AND ADULTS

Objective: Functional laryngeal dyskinesia (FLD) is characterized by s igns and symptoms of airway obstruction without anatomic basis. Failur e to recognize its features often leads to inappropriate diagnostic st udies and therapies. A systematic approach is presented for the recogn ition and management of patients with this disorder. Design: A retrosp ective case series at a large, urban tertiary care academic hospital. Methods: Retrospective review of charts of adults and children diagnos ed with FLD between 1979 and 1996. Presenting symptoms and signs of FL D were categorized and methods of diagnosis were recorded. Therapeutic interventions and resolution of FLD at follow-up were also analyzed. Results: Ten patients were identified with FLD, seven females and thre e males, with mean age of 25.9 years at diagnosis (range, 10-59 y), Pa tients were hospitalized a mean of three times (range, 1 to 6 admissio ns) before FLD was correctly diagnosed. Nine patients were receiving t reatment for asthma prior to diagnosis. Flow volume loops most often s howed a fixed extrathoracic inspiratory. Arterial blood gas and radiog raphic data were essentially normal. The most useful diagnostic test w as fiberoptic laryngoscopy, which showed abnormal adduction of the voc al cords on inspiration in the nine patients in this series who underw ent laryngoscopy. Conclusions: The authors' experience with FLD shows that its early recognition is associated with fewer interventions and their accompanying risks. A high degree of suspicion is required in th ese patients, who are often young and well educated They present with strider that may disappear while they are asleep or after distraction techniques.