Article

Pediatric Paradoxical Vocal-Fold Motion: Presentation and Natural History

Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
PEDIATRICS (Impact Factor: 5.47). 12/2011; 128(6):e1443-9. DOI: 10.1542/peds.2011-1003
Source: PubMed

ABSTRACT

To describe (1) a cohort of children with paradoxical vocal-fold motion (PVFM) who were referred to a multidisciplinary airway center and (2) the outcomes of various treatment modalities including speech therapy, gastroesophageal reflux disease treatment, and psychiatric treatment.
This was a case series with chart review of children younger than 18 years with PVFM evaluated at a tertiary care pediatric airway center over a 36-month period.
Fifty-nine children with PVFM were evaluated. The cohort had a mean age of 13.64 years (range: 8-18 years) and a female-to-male ratio of 3:1. Speech therapy as an initial treatment resulted in a 63% (24 of 38) success rate after an average of 3.7 treatment sessions. Speech therapy was a more successful treatment than antireflux therapy (P = .001). Ten percent (6 of 59) of the children presented with a known psychiatric diagnosis, and 30% (18 of 59) of children in the cohort were ultimately diagnosed with a psychiatric condition. Children with inspiratory stridor at rest had a lower initial success rate with speech therapy (56%), a higher rate of underlying psychiatric disorders (75%), and a high rate of success after psychiatric treatment (100%) that required, on average, 3 sessions over a 2-month period.
To our knowledge, this is the largest study to date on pediatric PVFM. The majority of children with PVFM improve with speech therapy. Children with PVFM at rest may be better treated with psychiatric therapy than speech therapy. Furthermore, children who present with symptoms at rest may have a higher likelihood of underlying psychiatric disease.

Full-text preview

Available from: pediatrics.aappublications.org
  • Source
    • "Many of the terms imply a significant psychological component, and this perceived link between psychological dysfunction and DB is one of the reasons physicians often avoid this area. Similarly, the relatively well characterised form of DB known as paradoxical vocal cord dysfunction (pVCD) [32] [33] [34] [35] [36] [37] has been labelled factitious asthma, functional stridor, episodic laryngeal dyskinesia, hysterical croup and psychogenic stridor [33]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Dysfunctional breathing (DB) is common, frequently unrecognised and responsible for a substantial burden of morbidity. Previously lack of clarity in the use of the term and the use of multiple terms to describe the same condition has hampered our understanding. DB can be defined as an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms. It can be subdivided into thoracic and extra thoracic forms. Thoracic DB is characterised by breathing patterns involving relatively inefficient, excessive upper chest wall activity with or without accessory muscle activity. This is frequently associated with increased residual volume, frequent sighing and an irregular pattern of respiratory effort. It may be accompanied by true hyperventilation in the minority of subjects. Extra thoracic forms include paradoxical vocal cord dysfunction and the increasingly recognised supra-glottic 'laryngomalacia' commonly seen in young sportsmen and women. While the two forms would appear to be two discreet entities they often share common factors in aetiology and respond to similar interventions. Hence both forms are considered in this review which aims to generate a more coherent approach to understanding, diagnosing and treating these conditions. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Full-text · Article · Nov 2014 · Paediatric respiratory reviews
  • Source
    • "Many of the terms imply a significant psychological component, and this perceived link between psychological dysfunction and DB is one of the reasons physicians often avoid this area. Similarly, the relatively well characterised form of DB known as paradoxical vocal cord dysfunction (pVCD) [32] [33] [34] [35] [36] [37] has been labelled factitious asthma, functional stridor, episodic laryngeal dyskinesia, hysterical croup and psychogenic stridor [33]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Dysfunctional breathing/hyperventilation syndrome is a breathing problem that involves breathing using a poor pattern or breathing too deeply or too rapidly (or both) (hyperventilation). There are many possible causes of dysfunctional breathing and if left untreated it can lead to a variety of unpleasant symptoms such as breathlessness, dizziness, pins and needles and chest pain. Little is known about dysfunctional breathing in children. Preliminary data suggest that at least 5.3% of children with asthma have dysfunctional breathing but no accepted recommendations are available for the treatment of these children. Dysfunctional breathing is currently treated using breathing exercises where the overall aim is to teach the patient to breathe gently using the lower part of their chest at a rate that matches their activity level. Review questionThe aim of this review was to investigate whether breathing exercises are useful in the treatment of children with dysfunctional breathing. Key resultsWe found no suitable trials that evaluated the use of breathing exercises in the management of children with dysfunctional breathing. Currently there is no evidence to support or refute the use of breathing exercises in children with dysfunctional breathing and randomised controlled trials are needed. This Cochrane plain language summary is up to date as of October 2013.
    Full-text · Article · Dec 2013 · Cochrane database of systematic reviews (Online)
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the status of the recent literature focused on studying the assessment and treatment of pediatric voice and airway disorders using both established and novel techniques. Recent research regarding voice assessment and treatment reveals the use of systematic and innovative approaches when collecting instrumental and perceptual voice data. There are recent advancements in certain surgical interventions designed to minimize complications. Wider use of functional endoscopic imaging of the pediatric larynx is improving our understanding of childhood voice production and airway management. There is also an important emerging focus on quantifying the impact of having a childhood voice disorder through the use of new tools. Although there is an increase in pediatric voice and airway research, many studies tend to be entirely descriptive rather than quantitative. There continues to be little specific research that uses prospective, longer-term and formal voice outcomes before and after behavioral and surgical interventions. Pediatric voice and airway disorders are an important childhood health problem. Voice assessment in children should include formal perceptual and instrumental evaluations, including sophisticated acoustic, aerodynamic and imaging modalities. The care of these children requires a collaborative approach that includes systematic and innovative treatment methods.
    No preview · Article · May 2012 · Current opinion in otolaryngology & head and neck surgery
Show more