A Systematic Review of Psychological Interventions for Adult and Pediatric Patients with Vocal Cord Dysfunction

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.

Trauma‐informed care improves management of paradoxical vocal fold movement patients

“…These findings are in concordance with previous research on PVFM and a history of emotional stress or an underlying psychological disorder in up to 70% of patients . The history of PVFM is deeply rooted in a psychological background.…”

“…PVFM has been reported to have a psychological relationship and/or underlying psychological diagnosis in up to 70% of patients . PVFM has had many psychological‐based terms upon its initial recognition of pathophysiology, including hysterical croup and psychogenic stridor , both owing tribute to underlying psychological disorders.…”

Co‐morbidities in severe asthma: Clinical impact and management

“…Potential triggers of VCD are the conditions that lead to increased laryngeal sensitivity such as postnasal drip and gastroesophageal reflux, as well as respiratory infections . However, a large proportion of patients appear to have a functional component, with pathopsychological traits such as signs of conversion disorder …”

“…Psychological interventions in VCD have only been examined in case series, and there is a need for prospective, randomized studies to clarify the clinical efficacy of these interventions …”

“…51 However, a large proportion of patients appear to have a functional component, with pathopsychological traits such as signs of conversion disorder. 52,53 Asthma patients with VCD report poorer asthma control. Overall, asthma patients with coexisting VCD report more exacerbations, are hospitalized more frequently and use more anti-asthmatic medications including oral prednisolone.…”