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Andrew LM, Sandler CB, Long CA, Bauman NM, Mudd PA. Exploring Mental Health in a Pediatric Paradoxical Vocal Fold Motion Sample Using Patient-Reported Outcomes. Otolaryngol Head Neck Surg 2024; 170:1167-1172. [PMID: 38193359 DOI: 10.1002/ohn.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Paradoxical vocal fold motion (PVFM) is characterized by inappropriate adduction of vocal folds during inspiration causing dyspnea. While anxiety is suspected to be a predisposing factor, incidence has been understudied. STUDY DESIGNS Retrospective review. SETTING Multidisciplinary PVFM hospital clinic. METHODS We used patient-reported outcome measures to examine anxiety and depression in consecutive patients aged 10 to 17 years using Pediatric SFv1.1 Anxiety 8b and Level 2-Depression inventories (parents completed proxy forms). T-scores were classified as normal (none to slight <55) or elevated (mild 55-59.9, moderate 60-69.9, severe >70). RESULTS Twenty-three pediatric patients and 20 parents completed surveys. Mean age was 13.74 years. For anxiety, 69.6% of patients and 40% of parents identified elevated levels. For depression, 30.4% of patients and 15% of parents identified elevated levels. Therapy need for the sample was 65.2% (34.8% active in services and 30.4% referred). Child anxiety scores were significantly higher in the therapy need group, U = 17, P = .004. CONCLUSION This study of adolescents with PVFM confirmed elevated anxiety and depression scores in 2/3 of the participants. Anxiety likely precedes diagnosis and is a predisposing factor. Referral for individualized intervention targeting anxiety and depression is indicated.
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Affiliation(s)
- Lilia Mucka Andrew
- Psychology, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Claire B Sandler
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Courtney A Long
- Hearing and Speech, Children's National Hospital, Washington, DC, USA
| | - Nancy M Bauman
- Otolaryngology, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Pamela A Mudd
- Otolaryngology, Children's National Hospital, George Washington University, Washington, DC, USA
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2
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Döllinger M, Jakubaß B, Cheng H, Carter SJ, Kniesburges S, Aidoo B, Lee CH, Milstein C, Patel RR. Computational fluid dynamics of upper airway aerodynamics for exercise-induced laryngeal obstruction: A feasibility study. Laryngoscope Investig Otolaryngol 2023; 8:1294-1303. [PMID: 37899858 PMCID: PMC10601582 DOI: 10.1002/lio2.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Use of computational fluid dynamic (CFD) simulations to measure the changes in upper airway geometry and aerodynamics during (a) an episode of Exercise-Induced Laryngeal Obstruction (EILO) and (b) speech therapy exercises commonly employed for patients with EILO. Methods Magnetic resonance imaging stills of the upper airway including the nasal and oral cavities from an adult female were used to re-construct three-dimensional geometries of the upper airway. The CFD simulations were used to compute the maximum volume flow rate (l/s), pressure (Pa), airflow velocity (m/s) and area of cross-section opening in eight planes along the vocal tract, separately for inhalation and exhalation. Results Numerical predictions from three-dimensional geometrical modeling of the upper airway suggest that the technique of nose breathing for inhalation and pursed lip breathing for exhalation show most promising pressure conditions and cross-sectional diameters for rescue breathing exercises. Also, if EILO is due to the constriction at the vocal fold level, then a quick sniff may also be a proper rescue inhalation exercise. EILO affects both the inspiratory and the expiratory phases of breathing. Conclusions A prior knowledge of the supraglottal aerodynamics and the corresponding upper airway geometry from CFD analysis has the potential to assist the clinician in choosing the most effective rescue breathing technique for optimal functional outcome of speech therapy intervention in patients with EILO and in understanding the pathophysiology of EILO on a case-by-case basis with future studies. Level of Evidence 4.
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Affiliation(s)
- Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck SurgeryUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Bernhard Jakubaß
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck SurgeryUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Hu Cheng
- Department of Psychological and Brain Sciences, Program of NeuroscienceIndiana UniversityBloomingtonIndianaUSA
| | - Stephen J. Carter
- Department of KinesiologySchool of Public Health, Indiana UniversityBloomingtonIndianaUSA
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck SurgeryUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Bea Aidoo
- Department of MedicineIndiana University School of MedicineBloomingtonIndianaUSA
| | - Chi Hwan Lee
- Department of Biomedical Engineering & Mechanical EngineeringPurdue UniversityWest LafayetteIndianaUSA
| | - Claudio Milstein
- Department of Otolaryngology‐Head & Neck Surgery, Cleveland Clinic Lerner and Case Western Reserve University Schools of MedicineHead and Neck Institute, Cleveland ClinicClevelandOhioUSA
| | - Rita R. Patel
- Department of Speech, Language, and Hearing Sciences and Department of Otolaryngology Head and Neck SurgeryIndiana UniversityBloomington/IndianapolisIndianaUSA
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3
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Butler J, Asbridge H, Stringer H. Applying behaviour change theory to speech and language therapy intervention for inducible laryngeal obstruction. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1539-1550. [PMID: 37070211 DOI: 10.1111/1460-6984.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Speech and language therapists (SLTs) provide interventions for inducible laryngeal obstruction (ILO) despite a current lack of evidence to inform intervention delivery. This study is the first step to develop an evidence-based intervention for ILO, using behaviour change theory and the Behaviour Change Technique Taxonomy version 1 (BCTTv1). Outcomes will inform the early development stage of a complex speech and language therapy intervention for ILO, enabling more precise reporting of ILO intervention studies, as per CONSORT guidelines. AIMS (1) To identify whether the BCTTv1 is a useful tool for characterising speech and language therapy interventions for ILO, based on existing literature, current practice and patient interviews. (2) To identify key behaviour change techniques (BCT) used within existing complex speech and language therapy interventions for ILO METHODS AND PROCEDURES: A five-phase study was conducted: (1) a systematic literature search of six electronic databases (Medline, EMBASE, CINAHL (EBSCO), Scopus, Trip, Web of Science) and grey literature between 2008 and 2020; (2) observations of six speech and language therapy intervention sessions; (3) a semi-structured interview with an SLT to validate the observed BCTTs; (4) consensus from four national expert SLTs regarding application of synthesised BCTT data to their own experiences of ILO interventions; and (5) patient engagement to review and comment on findings. OUTCOMES AND RESULTS Forty-seven BCTs in total were coded across all three sources. Thirty-two BCTs were identified in clinical observations; 31 in interviews with SLTs and 18 in the literature. Only six BCT were identified in all three sources. Expert SLTs confirmed clinical application and relevance. Patients reported finding the concept of BCT challenging but highlighted the value of psychoeducation to support their understanding of symptoms and in turn to understand the rationale behind speech and language therapy intervention recommendations. CONCLUSION This study indicates that the BCTTv1 is a suitable framework to identify and describe intervention components used within speech and language therapy interventions for ILO. A practice-research gap exists, reinforcing that existing literature does not capture the complexity of speech and language therapy intervention for ILO. Further research is needed to develop our understanding of the BCTs that support optimal behaviour change for this patient group. WHAT THIS PAPER ADDS What is already known on the subject There is growing recognition for the value of speech and language therapists (SLTs) in delivering complex interventions for patients with inducible laryngeal obstruction (ILO), including evidence to suggest that their intervention can improve quality of life for patients and reduce excessive healthcare use. There are, however, no randomised controlled trials in this field; thus it is unclear what constitutes the most effective intervention. What this study adds This study demonstrates the complexity of speech and language therapy interventions for ILO and highlights the practice-research gap. It identifies a range of behaviour change techniques that are used in existing practice and captures patient views relating to the components identified within this study. What are the clinical implications of this work? Findings highlight the value of providing education about factors that might be driving ILO symptoms and in turn the importance of sharing with patients the rationale for treatment recommendations that necessitate a change in their behaviours. Identified behaviour change techniques can be used when developing and implementing SLT interventions for ILO.
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Affiliation(s)
- Jennifer Butler
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, Rake Lane, North Shields, NE29 8NH, UK
- Department of Speech and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah Asbridge
- Department of Speech and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
- University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Helen Stringer
- University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
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Goit R, Oli PR, Le Q, Bhandari A. Paradoxical Vocal Fold Dysfunction Mimicking Bronchial Asthma in a Young Female Patient. Cureus 2023; 15:e41376. [PMID: 37546109 PMCID: PMC10400364 DOI: 10.7759/cureus.41376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Inducible laryngeal obstruction (ILO)/paradoxical vocal fold motion (PVFM) is a reversible narrowing of the larynx that results from vocal fold motion dysfunction. Distinguishing ILO from asthma can be challenging, as they can coexist, and standard tests may not be able to differentiate between the two. However, a flexible laryngoscopy can promptly diagnose ILO. Unfortunately, ILO is often overlooked as a potential cause when evaluating patients with sudden-onset breathing difficulties and respiratory distress. We present a case of a young female who sought frequent treatment at the emergency room (ER) with symptoms of shortness of breath (SOB), rapid heart rate, rapid breathing, and anxiety. Despite receiving treatment for acute asthma attacks, her symptoms persisted. During her most recent hospital admission, a flexible laryngoscopy revealed abnormal vocal fold movements, indicating paradoxical vocal fold dysfunction (PVFD) and muscle tension dysphonia (MTD). A comprehensive treatment approach involving speech therapy, pulmonology, and psychiatry led to significant clinical improvement. This case report highlights the importance of raising awareness among healthcare providers about ILO potentially mimicking bronchial asthma exacerbation.
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Affiliation(s)
- Raman Goit
- Internal Medicine, Kathmandu Medical College, Kathmandu, NPL
| | | | - Quang Le
- Hospital Medicine, University of Missouri School of Medicine, Columbia, USA
| | - Amit Bhandari
- Internal Medicine, St John's Hospital, Springfield, USA
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5
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Schonman I, Mudd PA, Ivancic R, Ryan MA, Ongkasuwan J, Prager J, Smith ME, Goudy SL, Rana MS, Wiet GJ, Bauman NM. Multi-Institutional Study of Patient-Reported Outcomes of Paradoxical Vocal Fold Motion. Laryngoscope 2023; 133:970-976. [PMID: 35730686 DOI: 10.1002/lary.30256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To explore patient-reported outcome measures of pediatric paradoxical vocal fold motion through a multi-institutional study of geographically diverse United States medical facilities to assess long-term management and outcomes. METHODS Eligible participants >8 years of age diagnosed with PVFM over a 10-year period from 7 tertiary pediatric hospitals were invited to complete a survey addressing study objectives. RESULTS 65 participants completed the survey, of whom 80% were female, 75% reported a 3.5 grade point average or better, and 75% identified as competitive athletes or extremely athletic individuals. Participants rated their perceived efficacy of 13 specific treatments. Only five treatments were considered effective by a majority of the participants who tried them. The treatments that participants tried most often were breathing exercises (89.2%), bronchodilator treatments (45%), and allergy medications (35.4%). 78.8% of participants reported receiving more than one treatment and 25% reported receiving a combination of bronchodilators, anticholinergics, and steroids. At the time of PVFM diagnosis, 38% of participants had no idea when their symptoms would completely resolve. 23.3% of participants did not experience symptom resolution until greater than 1 year after diagnosis. CONCLUSIONS Traditional management tools such as breathing exercises and biofeedback treatments may not provide the long-term benefit that providers anticipate. In addition to these commonly used management strategies, highly efficacious techniques such as counseling and lifestyle management should be incorporated into the long-term management of patients whose symptoms are refractory to traditional care. LEVEL OF EVIDENCE 4 Laryngoscope, 133:970-976, 2023.
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Affiliation(s)
- Ian Schonman
- GW School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Pamela A Mudd
- Department of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
| | - Ryan Ivancic
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marisa A Ryan
- Department of Otolaryngology, Johns Hopkins Children's Center, Baltimore, Maryland, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology, Texas Children's Hospital, Houston, Texas, USA
| | - Jeremy Prager
- Department of Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Marshall E Smith
- Department of Otolaryngology, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Steven L Goudy
- Department of Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Md Sohel Rana
- Department of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
| | - Gregory J Wiet
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nancy M Bauman
- Department of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
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6
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Muralitharan P, Carlsen P, Hilland M, Delestre-Levai I, Vollsæter M, Hufthammer KO, Engan M, Røksund OD, Halvorsen T, Clemm HH. Use of inhaled ipratropium bromide to improve exercise-induced laryngeal obstruction cannot be recommended. ERJ Open Res 2023; 9:00308-2022. [PMID: 36699648 PMCID: PMC9868967 DOI: 10.1183/23120541.00308-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young adults. Current management generally consists of breathing advice, speech therapy, inspiratory muscle training or supraglottoplasty in highly motivated subjects with supraglottic collapse. Inhaled ipratropium bromide (IB) is a muscarinic receptor antagonist used to treat asthma that is suggested in a few reports to improve EILO symptoms. The aim of the present study was to investigate effects of inhaled IB in EILO diagnosed by continuous laryngoscopy exercise (CLE) test and classified by CLE scores. Methods A randomised crossover trial was conducted at Haukeland University Hospital, Bergen, Norway, enrolling participants diagnosed with EILO defined by characteristic symptoms and CLE score ≥3 (range 0-12). Two consecutive CLE tests were performed within 2 weeks, one test with and one test without prior administration of inhaled IB in a randomised order. Main outcomes were the CLE score, dyspnoea measured using a modified BORG scale (range 0-10) and cardiopulmonary exercise data provided by the CLE test. Results 20 participants (14 females) aged 12-25 years participated, and all ran to exhaustion on both tests. Mean CLE score, BORG score and peak oxygen consumption were similar in tests performed with and without IB; mean differences (95% confidence interval) were 0.08 (-0.28-0.43), 0.35 (-0.29-0.99) and -0.4 (-1.9-1.1) mL·kg-1·min-1, respectively. Conclusion Inhaled IB did not improve CLE score, dyspnoea or exercise capacity in subjects with EILO. The study does not support the use of inhaled IB to treat EILO.
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Affiliation(s)
- Praveen Muralitharan
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Corresponding author: Praveen Muralitharan ()
| | - Petter Carlsen
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Magnus Hilland
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Irisz Delestre-Levai
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Mette Engan
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ola Drange Røksund
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege H. Clemm
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway
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7
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Koh J, Phyland D, Baxter M, Leong P, Bardin PG. Vocal cord dysfunction/inducible laryngeal obstruction: novel diagnostics and therapeutics. Expert Rev Respir Med 2023; 17:429-445. [PMID: 37194252 DOI: 10.1080/17476348.2023.2215434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is an important medical condition but understanding of the condition is imperfect. It occurs in healthy people but often co-exists with asthma. Models of VCD/ILO pathophysiology highlight predisposing factors rather than specific mechanisms and disease expression varies between people, which is seldom appreciated. Diagnosis is often delayed, and the treatment is not evidence based. AREAS COVERED A unified pathophysiological model and disease phenotypes have been proposed. Diagnosis is conventionally made by laryngoscopy during inspiration with vocal cord narrowing >50% Recently, dynamic CT larynx was shown to have high specificity (>80%) with potential as a noninvasive, swift, and quantifiable diagnostic modality. Treatment entails laryngeal retraining with speech pathology intervention and experimental therapies such as botulinum toxin injection. Multidisciplinary team (MDT) clinics are a novel innovation with demonstrated benefits including accurate diagnosis, selection of appropriate treatment, and reductions in oral corticosteroid exposure. EXPERT OPINION Delayed diagnosis of VCD/ILO is pervasive, often leading to detrimental treatments. Phenotypes require validation and CT larynx can reduce the necessity for laryngoscopy, thereby fast-tracking diagnosis. MDT clinics can optimize management. Randomized controlled trials are essential to validate speech pathology intervention and other treatment modalities and to establish international standards of care.
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Affiliation(s)
- Joo Koh
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
| | - Debra Phyland
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Malcolm Baxter
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
| | - Paul Leong
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
- Hudson Institute, Monash Hospital and University, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
- Hudson Institute, Monash Hospital and University, Melbourne, Australia
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8
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Zhang C, Hicks M, Ospina MB, Martha V, Alnouri G, Dennett L, Sataloff R, Hicks A. The impact of identifying laryngeal obstruction syndromes on reducing treatment of pediatric asthma: A systematic review. Pediatr Pulmonol 2022; 57:1401-1415. [PMID: 35355450 PMCID: PMC9321614 DOI: 10.1002/ppul.25910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 11/11/2022]
Abstract
Inducible laryngeal obstruction (ILO) in children is underrecognized. This systematic review characterizes the scientific evidence on the impact of pediatric ILO diagnosis and treatment on asthma medication use. This review, registered with PROSPERO (CRD42020209168), utilized database searches in MEDLINE, EMBASE, CINAHL, and Web of Science from inception to October 2020. Both experimental and observational studies on ILO and asthma outcomes in patients ≤18 years were included. Population characteristics (sample size, sex, age, and comorbidities) and study outcomes (medication usage and respiratory symptoms) were extracted. The risk of bias was assessed with the National Toxicology Program's Office of Health Assessment and Risk of Bias Rating Tool. Data are presented narratively due to study heterogeneity. Of 1091 studies, 1076 titles and abstracts were screened after duplicate removal. Screening 31 full texts yielded eight pre-post studies. Patients were an average of 14.1 years old, 15% male, and >90% used asthma medication; 40% reported allergies, 30% gastroesophageal reflux, and 20% anxiety or depression. Most patients received at least one intervention, with 75% showing symptomatic improvement and >75% decreasing or stopping asthma medications. Studies were small with a high risk of selection, confounding, and detection bias. Asthma management was not a primary outcome in any of the studies. Overall, ILO patients were often diagnosed with or treated for asthma before ILO diagnosis. Evidence from individual studies suggests that comorbidities including ILO, gastroesophageal reflux, allergies, and anxiety should be considered in pediatric patients with asthma not responsive to medical therapy. Further research is required to determine the proportion of impacted asthma patients.
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Affiliation(s)
- Caseng Zhang
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Matt Hicks
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Maria B Ospina
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Vishnu Martha
- Department of Otolaryngology, Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ghiath Alnouri
- Department of Otolaryngology, Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Liz Dennett
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Robert Sataloff
- Department of Otolaryngology, Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Anne Hicks
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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9
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Fukusho R, Ruane L, Phyland D, Koh J, Avram A, Leong P, MacDonald M, Lau KK, Baxter M, Bardin PG. A multidisciplinary team clinic for vocal cord dysfunction reduces corticosteroid burst therapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:612-614.e1. [PMID: 34718216 DOI: 10.1016/j.jaip.2021.10.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/22/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Risa Fukusho
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia
| | - Laurence Ruane
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Hudson Institute, Melbourne, VIC, Australia
| | - Debra Phyland
- Otolargyngology, Monash Health and University, Melbourne, VIC, Australia
| | - Joo Koh
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Otolargyngology, Monash Health and University, Melbourne, VIC, Australia
| | - Adriana Avram
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia
| | - Paul Leong
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Hudson Institute, Melbourne, VIC, Australia
| | - Martin MacDonald
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Hudson Institute, Melbourne, VIC, Australia
| | - Kenneth K Lau
- Diagnostic Imaging, Monash Health and University, Melbourne, VIC, Australia
| | - Malcolm Baxter
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Otolargyngology, Monash Health and University, Melbourne, VIC, Australia
| | - Philip G Bardin
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Hudson Institute, Melbourne, VIC, Australia.
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10
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Sandnes A, Andersen T, Clemm HH, Hilland M, Heimdal JH, Halvorsen T, Røksund OD, Vollsæter M. Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction. Eur Arch Otorhinolaryngol 2021; 279:2511-2522. [PMID: 34954812 PMCID: PMC8986676 DOI: 10.1007/s00405-021-07214-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/03/2021] [Indexed: 11/09/2022]
Abstract
Purpose Exercise-induced laryngeal obstruction (EILO) is relatively common in young people. Treatment rests on poor evidence; however, inspiratory muscle training (IMT) has been proposed a promising strategy. We aimed to assess laryngeal outcomes shortly after IMT, and to compare self-reported symptoms with a control group 4–6 years later. Methods Two groups were retrospectively identified from the EILO-register at Haukeland University Hospital, Norway; one group had received only information and breathing advice (IBA), and another additionally IMT (IBA + IMT). At diagnosis, all participants performed continuous laryngoscopy during exercise (CLE), with findings split by glottic and supraglottic scores, and completed a questionnaire mapping exercise-related symptoms. After 2–4 weeks, the IBA + IMT-group was re-evaluated with CLE-test. After 4–6 years, both groups were re-assessed with a questionnaire. Results We identified 116 eligible patients from the EILO-register. Response rates after 4–6 years were 23/58 (40%) and 32/58 (55%) in the IBA and IBA + IMT-group, respectively. At diagnosis, both groups rated symptoms similarly, but laryngeal scores were higher in the IBA + IMT-group (P = 0.003). After 2–4 weeks, 23/32 in the IBA + IMT-group reported symptom improvements, associated with a decrease of mainly glottic scores (1.7–0.3; P < 0.001), contrasting unchanged scores in the 9/32 without symptom improvements. After 4–6 years, exercise-related symptoms and activity levels had decreased to similar levels in both groups, with no added benefit from IMT; however, full symptom resolution was reported by only 8/55 participants. Conclusion Self-reported EILO symptoms had improved after 4–6 years, irrespective of initial treatment. Full symptom resolution was rare, suggesting individual follow-up should be offered. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-07214-5.
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Affiliation(s)
- Astrid Sandnes
- Department of Internal Medicine, Innlandet Hospital Trust, Gjøvik, Norway. .,Institute of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Tiina Andersen
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway.,Thoracic Department, Norwegian Advisory Unit on Home Mechanical Ventilation, Bergen, Norway.,The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hege Havstad Clemm
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Magnus Hilland
- Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - John-Helge Heimdal
- Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway.,Institute of Surgical Science, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Maria Vollsæter
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway.,Thoracic Department, Norwegian Advisory Unit on Home Mechanical Ventilation, Bergen, Norway
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11
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12
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Wenzel M. Gasping for a Diagnosis: Pediatric Vocal Cord Dysfunction. J Pediatr Health Care 2019; 33:5-13. [PMID: 29657076 DOI: 10.1016/j.pedhc.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 03/11/2018] [Indexed: 02/05/2023]
Abstract
Vocal cord dysfunction is an obstruction of the upper airway, primarily on inspiration, due to the paradoxical adduction of the vocal cords. Vocal cord dysfunction continues to be underdiagnosed as its own entity. The lack of diagnosis can be attributed to the overlap of symptoms between asthma and exercise-induced bronchospasm. It is possible for patients diagnosed with asthma and/or exercise-induced bronchospasm to have underlying vocal cord dysfunction, which needs to be considered when prescribing asthma medications. This article will review the history of vocal cord dysfunction, the differential diagnosis, diagnostic testing, and the role of the nurse practitioner in caring for these patients.
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O'Connell Ferster AP, Shokri T, Carr M. Diagnosis and treatment of paradoxical vocal fold motion in infants. Int J Pediatr Otorhinolaryngol 2018; 107:6-9. [PMID: 29501313 DOI: 10.1016/j.ijporl.2018.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Paradoxical vocal fold motion (PVFM) is a disorder often misdiagnosed in children presenting with shortness of breath and stridor. In infants, little is known about the clinical course and best approach for treatment of PVFM. This retrospective study assesses the approach to treatment and outcomes for infants with PVFM. OBJECTIVE To investigate the clinical course of paradoxical vocal fold motion (PVFM) in infants. DESIGN Retrospective review. SETTING Tertiary academic medical center. PARTICIPANTS Patients less than 2 years of age diagnosed with PVFM were identified and included in the study. MAIN OUTCOMES AND MEASURES History, physical exam findings, and clinical course of treatment for patients less than 2 years old with PVFM were reviewed. Findings including those on flexible fiberoptic laryngoscopy (FFL) and subjective assessment by parents and clinicians were compiled for review. RESULTS Seven infants were diagnosed with PVFM. All patients were full term at birth, and average age at diagnosis was 7 months. All patients initially presented with inspiratory stridor, and two patients had stertor. Two of seven patients also had a history of reactive airway disease and one with laryngomalacia. Five had a history of reflux. Two of seven patients had weight percentiles at diagnosis lower than the 25th percentile, while the remainder were between 37th and 75th percentiles. Initial voice evaluation revealed stridor in all patients, as well as finding of PVFM on FFL. All patients were started on anti-reflux medication. Average time to resolution of PVFM was 5.9 months after treatment. CONCLUSIONS PVFM can be challenging to diagnose in the infant population. PVFM resolves uneventfully with reflux treatment, however, it is unknown whether reflux treatment is essential or if PVFM would spontaneously resolve. The rarity of infantile PVFM mandates formal evaluation and monitoring by a pediatric otolaryngologist.
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Affiliation(s)
- Ashley P O'Connell Ferster
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States.
| | - Tom Shokri
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States
| | - Michele Carr
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, United States
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Abstract
Exertional dyspnea is common in health and disease. Despite having known for centuries that breathlessness can arise from the larynx, exercise-induced laryngeal obstruction is a more prevalent condition than previously assumed. This article provides a brief overview of the history, epidemiology, and pathophysiology of exercise-induced laryngeal obstruction.
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Drake K, Palmer AD, Schindler JS, Tilles SA. Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults. Folia Phoniatr Logop 2018; 69:154-168. [PMID: 29393222 DOI: 10.1159/000484716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/30/2017] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Paradoxical vocal fold motion (PVFM) is responsive to behavioral therapy, often resulting in a remission of symptoms, but little is known about whether treatment is beneficial with regard to PVFM-associated psychological symptoms or functional limitations. The goal of the study was to identify patient perceptions of the impact of treatment for PVFM and characteristics associated with treatment outcomes. METHODS A survey was conducted of all adults who had received at least 1 session of treatment for PVFM in our outpatient clinic over a 2-year period. RESULTS The 39 participants ranged in age from 18 to 82 and had received a median of 3 treatment sessions. At a median follow-up of 10 months following treatment, respondents reported improvements in a wide range of areas, including sports and leisure, daily activities, and social participation. The majority reported improvements in feelings of anxiety, helplessness, and control. Poorer outcomes were associated with more severe voice symptoms, fewer treatment sessions, and needing oral steroids for asthma control. CONCLUSION There was a reduction in a wide range of activity limitations after treatment. Feelings of control were strongly associated with positive outcomes. The therapy appeared to be equally effective for adults with exercise-induced and environmental variants of PVFM.
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Affiliation(s)
- Karen Drake
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Andrew D Palmer
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Joshua S Schindler
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Smith B, Milstein C, Rolfes B, Anne S. Paradoxical vocal fold motion (PVFM) in pediatric otolaryngology. Am J Otolaryngol 2017; 38:230-232. [PMID: 28139319 DOI: 10.1016/j.amjoto.2017.01.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Paradoxical vocal fold motion (PVFM) is a condition in which the vocal cords exhibit inappropriate inspiratory adduction, and it has been poorly studied in the pediatric population. METHODS Pediatric patients diagnosed with PVCM by a pediatric otolaryngologist and doctor of speech pathology from 2008 to 2012 were reviewed. Patients in whom another cause for their respiratory disturbance was eventually identified were excluded. Patient demographics, characteristics, treatment, and outcomes were reviewed. The study was approved by the Institutional Review Board at our institution. RESULTS Thirty patients met criteria for inclusion; one with chiari malformation was excluded. 17/29 (59%) were female. Body mass index (BMI) numbers ranged from 16 to 25 with a mean of 21. 9/29 (31%) competed at the highest level of a sport; only 3/29 (10%) did not participate in athletics. Average age of onset was 12.0years; average diagnosis delay was 1.3years. Mean follow up was 2.3years. 24/29 (83%) were previously treated for asthma. 23/29(79%) were previously treated for reflux. 25/29(86%) completed at least one session of respiratory and laryngeal control therapy with overall average of 2.2 sessions completed. All patients who attended a second therapy session were recorded as having improvement in symptoms. CONCLUSIONS Pediatric patients with PVFM often participate in high levels of organized sports and the frequency of concurrent asthma and reflux symptoms in this population supports the theory that laryngeal hypersensitivity contributes to the pathophysiology of PVFM. These patients were not found to have any associated psychiatric diagnoses. Pediatric patients with PVFM have an excellent prognosis when treated with speech therapy and for comorbid conditions as indicated.
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Affiliation(s)
- Blake Smith
- Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States.
| | - Claudio Milstein
- Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States
| | - Bryan Rolfes
- Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States
| | - Samantha Anne
- Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States
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Paradoxical vocal fold motion in children presenting with exercise induced dyspnea. Int J Pediatr Otorhinolaryngol 2016; 90:165-169. [PMID: 27729125 DOI: 10.1016/j.ijporl.2016.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/04/2016] [Accepted: 09/09/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Although dyspnea with exercise in the pediatric population can be multifactorial, the diagnosis of paradoxical vocal fold motion disorder (PVFMD) in this group is not well characterized. The objective of this study is to review the multiple causes of dyspnea with exercise in children, including the prevalence of PVFMD within this study population. METHODS A retrospective review was conducted of patients seen at a tertiary pediatric hospital for exercise-induced dyspnea suspected to be related to PVFMD between January 2007 and July 2015. Inclusion criteria included assessment in a specialty exercise clinic and evaluation by a pediatric otolaryngologist and pulmonologist. Pre- and post-exercise pulmonary function tests and laryngoscopic examinations were performed. Data including co-morbidities, presenting symptoms, prior diagnoses and treatments, final diagnoses, prescribed treatments and outcomes were collected and analyzed. RESULTS 294 patients were evaluated at our institution during the study period. 4 patients were excluded for insufficient data, which left 290 for analysis. 75 were male, 215 female. All patients underwent treadmill testing with monitoring to simulate strenuous exercise. Average patient age was 14.6 years; average BMI was 21.53. The most common sports to elicit symptoms were running and soccer. Patients most frequently complained of stridor or wheezing in addition to dyspnea. Throat tightness was also a common complaint. After evaluation, 86 patients were given the primary diagnosis of exercise-induced PVFMD. 54 patients were diagnosed with physiologic dyspnea and 30 with exercise-induced asthma. CONCLUSION Pediatric patients presenting with exercise-induced dyspnea can have multiple etiologies for their symptoms including PVFMD. Other causes of dyspnea with exercise should not be underestimated.
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Smoliga JM, Mohseni ZS, Berwager JD, Hegedus EJ. Common causes of dyspnoea in athletes: a practical approach for diagnosis and management. Breathe (Sheff) 2016; 12:e22-37. [PMID: 27408644 PMCID: PMC4933616 DOI: 10.1183/20734735.006416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Key points Educational aims Dyspnoea during exercise is a common chief complaint in athletes and active individuals. It is not uncommon for dyspnoeic athletes to be diagnosed with asthma, “exercise-induced asthma” or exercise-induced bronchoconstriction based on their symptoms, but this strategy regularly leads to misdiagnosis and improper patient management. Dyspnoea during exercise can ultimately be caused by numerous respiratory and nonrespiratory conditions, ranging from nonpathological to potentially fatal in severity. As, such it is important for healthcare providers to be familiar with the many factors that can cause dyspnoea during exercise in seemingly otherwise-healthy individuals and have a general understanding of the clinical approach to this patient population. This article reviews common conditions that ultimately cause athletes to report dyspnoea and associated symptoms, and provides insight for developing an efficient diagnostic plan. Dyspnoea, fatigue and underperformance are often interrelated symptoms in athletes, and may have various causeshttp://ow.ly/4nsYnk
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Affiliation(s)
- James M Smoliga
- Dept of Physical Therapy, High Point University, High Point, NC, USA
| | - Zahra S Mohseni
- Dept of Biology, North Carolina State University, Raleigh, NC, USA
| | | | - Eric J Hegedus
- Dept of Physical Therapy, High Point University, High Point, NC, USA
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Patel RR, Venediktov R, Schooling T, Wang B. Evidence-Based Systematic Review: Effects of Speech-Language Pathology Treatment for Individuals With Paradoxical Vocal Fold Motion. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:566-584. [PMID: 25836980 DOI: 10.1044/2015_ajslp-14-0120] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 03/27/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE In this article, our goal was to determine the state of the evidence and the effect of speech-language pathology (SLP) treatment for individuals with paradoxical vocal fold motion (PVFM). METHOD The American Speech-Language-Hearing Association's National Center for Evidence-Based Practice in Communication Disorders searched 22 electronic databases using key words related to PVFM, speech or voice treatment, and behavioral intervention for articles published through July 2013. Identified articles were systematically evaluated to assess the quality of the evidence using a modification of the American Speech-Language-Hearing Association's critical appraisal scheme. RESULTS Sixty-five articles met the search criteria. Only 2 out of the 65 articles were judged to contain adequate evidence to evaluate the effect of SLP treatment for PVFM. All 65 articles exemplify the state of the evidence for SLP treatment for PVFM. CONCLUSION The state of the evidence for the use of SLP treatment is in its infancy, with a majority of articles in the exploratory stage of research. Consequently, few clinical implications can be drawn at this time. SLP treatment for PVFM is promising; however, there is clearly a pressing need for systematic experimental studies that involve a control group to further the evidence base.
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Guglani L, Atkinson S, Hosanagar A, Guglani L. A systematic review of psychological interventions for adult and pediatric patients with vocal cord dysfunction. Front Pediatr 2014; 2:82. [PMID: 25152871 PMCID: PMC4126208 DOI: 10.3389/fped.2014.00082] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 07/20/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vocal cord dysfunction (VCD) or paradoxical vocal-fold motion (PVFM) is a functional disorder of the vocal cords that requires multidisciplinary treatment. Besides relaxation techniques, the use of psychological interventions can help treat the underlying psychological co-morbidities. There is currently no literature that examines the effectiveness of psychological interventions for VCD/PVFM. OBJECTIVES To review the evidence for psychological interventions used for the treatment of patients with VCD/PVFM. DATA SOURCES We searched electronic databases for English medical literature using Pubmed (Medline), PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Registry of Controlled Trials, and Clinicaltrials.gov. The date range for our search is from June 1964 to June 2014. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS We included studies that reported the use of psychological interventions in both adults and children diagnosed with VCD/PVFM. We included randomized controlled trials, case-control studies, retrospective chart reviews, prospective case series, and individual case reports. RESULTS Most reported studies are small case series or individual case reports that have described the use of interventions such as psychotherapy, behavioral therapy, use of anti-anxiety and anti-depressant medications, and hypnotherapy in conjunction with breathing exercises taught by speech therapists for symptomatic relief. Among the various psychological interventions that have been reported, there is no data regarding effectiveness and/or superiority of one approach over another in either adult or pediatric patients. CONCLUSIONS Psychological interventions have a role to play in the management of adult and pediatric patients with VCD/PVFM. Future prospective studies using uniform approaches for treatment of associated psychopathology may help address this question.
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Affiliation(s)
- Loveleen Guglani
- Department of Communication Disorders, Wayne State University , Detroit, MI , USA
| | - Sarah Atkinson
- Wayne State University School of Medicine , Detroit, MI , USA
| | - Avinash Hosanagar
- Department of Psychiatry, Veterans Affairs Medical Center, University of Michigan Medical School , Ann Arbor, MI , USA
| | - Lokesh Guglani
- Division of Pulmonary Medicine, The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan , Detroit, MI , USA
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Gillespie AI, Helou LB, Ingle JW, Baldwin M, Rosen CA. The role of voice therapy in the treatment of dyspnea and dysphonia in a patient with a vagal nerve stimulation device. J Voice 2013; 28:59-61. [PMID: 24070591 DOI: 10.1016/j.jvoice.2013.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
Vagal nerve stimulators (VNS) are implanted to treat medically refractory epilepsy and depression. The VNS stimulates the vagus nerve in the left neck. Laryngeal side effects are common and include dysphagia, dysphonia, and dyspnea. The current case study represents a patient with severe dyspnea and dysphonia, persisting even with VNS deactivation. The case demonstrates the use of voice and respiratory retraining therapy for the treatment of VNS-induced dysphonia and dyspnea. It also highlights the importance of a multidisciplinary approach, including laryngology, neurology, and speech-language pathology, in the treatment of these challenging patients.
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Affiliation(s)
- Amanda I Gillespie
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Leah B Helou
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John W Ingle
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Maria Baldwin
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Clark A Rosen
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kelchner LN, Brehm SB, de Alarcon A, Weinrich B. Update on pediatric voice and airway disorders. Curr Opin Otolaryngol Head Neck Surg 2012; 20:160-4. [DOI: 10.1097/moo.0b013e3283530ecb] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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