CHEST Guidelines-Cricoarytenoid-Subluxation

Cricoarytenoid-Subluxation_chest

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The correspondence in the "Chest" journal describes a case of a 57-year-old woman initially misdiagnosed with difficult-to-treat asthma. Despite appropriate treatment, her symptom control was poor, leading to reassessment and the discovery of cricoarytenoid subluxation, a rare condition where the arytenoid cartilage is dislocated, often following intubation. This condition can mimic asthma by causing upper airway obstruction.<br /><br />The patient's asthma-like symptoms began after an appendectomy at the age of 15, which required endotracheal intubation. Despite receiving typical asthma medications, her symptoms persisted. Detailed examination, including laryngeal stroboscopy, identified cricoarytenoid joint hyperlaxity with a risk of vestibular stenosis during forced inspiration. Based on these findings, her bronchodilator medications were ceased and speech therapy was recommended. Over four years, the patient managed her symptoms effectively through learned speech therapy techniques without needing emergency services.<br /><br />Recognition of this condition is crucial for differential diagnosis in cases of asthma with poor response to conventional treatments. Cricoarytenoid subluxation is typically diagnosed through laryngoscopy or videostroboscopy, assessing the position and movement of the vocal cords and arytenoids. Treatment can vary from direct cartilage repositioning to surgical interventions, but in this case, conservative management with speech therapy proved effective, negating the need for surgery.<br /><br />This case study adds to medical knowledge by highlighting cricoarytenoid subluxation as an alternative cause of asthma-like symptoms, underscoring the need for thorough diagnosis in persistent cases. The authors emphasize including this condition in differential diagnoses for similar respiratory disorders mistakenly identified as asthma.

Keywords

cricoarytenoid subluxation

asthma misdiagnosis

laryngeal stroboscopy

upper airway obstruction

speech therapy

vocal cord assessment

differential diagnosis

respiratory disorders

conservative management

medical case study