• Asimina Paspala, Evdokia Sourla, Afroditi Boutou, Fotis Zoglopitis, Athanasia Pataka, Vasilis Bagalas, Ioannis Stanopoulos, and Georgia Pitsiou.
• Respiratory Failure Unit, General Hospital "G. Papanikolaou," Exohi, Thessaloniki, Greece.
• J Emerg Med. 2013 Nov 1;45(5):e145-8.

BackgroundBilateral 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.ObjectivesTo underlie the value of clinical examination and flow-volume loops in the establishment of diagnosis of upper airway obstruction.Case ReportWe 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.ConclusionVocal 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.Copyright © 2013 Elsevier Inc. All rights reserved.

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