A Trigger Reduction Approach to Treatment of Paradoxical Vocal Fold Motion Disorder in the Pediatric Population

Zalvan, Craig H.; Yuen, Erick; Geliebter, Jan; Tiwari, Raj K.

doi:10.1016/j.jvoice.2019.08.013

Cited by 11 publications

(7 citation statements)

References 16 publications

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“…To theoretically dampen the peripheral stimulation triggered by postnasal drainage, our regimen can potentially thin out and decrease the total amount of mucus, with its mix of cytokines and inflammatory mediators, draining into the nasopharynx. This approach may decrease the stimulation of various mechano and chemoreceptors implicated in the pathogenesis of dyspnea throughout the respiratory tract [5]. Furthermore, exposing human bronchial epithelium to a variety of respiratory viruses upregulates ASIC and TRPV1 expression, potentially contributing to the post-viral hypersensitivity often observed in dyspneic patients with no identifiable etiology [23].…”

Section: Recent Reports Of Viral-associated Olfactory Loss Secondary Tomentioning

confidence: 99%

“…To our knowledge, this is the first case series of patients with dyspnea not related to a readily identifiable underlying organic cardiopulmonary pathology or anatomical abnormality. Modelled after a trigger reduction treatment regimen for chronic neurogenic cough [4] and paradoxical vocal fold motion [5], we employed a therapeutic trigger reduction protocol including a 90-95 % plant-based, Mediterranean style diet with alkaline water to decrease Laryngopharyngeal Reflux (LPR) [6], saline irrigation, and combined azelastine/fluticasone nasal spray for basal post-nasal drip reduction. Theoretically decreasing the basal rate of nasal drainage and physiologic reflux results in less stimulation of the laryngopharyngeal tissues with less afferent stimulation.…”

Section: Introductionmentioning

confidence: 99%

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Neurogenic Dyspnea: Is Idiopathic Dyspnea Related to a Post-Viral Sensory Neuropathy? A Case Series Supporting a New Hypothesis

Zalvan¹,

E1²,

Cole³

et al. 2021

AustinJOtolaryngol

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Objective: To propose a hypothesis of a novel potentially post-viral sensory neuropathic disorder, termed neurogenic dyspnea, and assess the therapeutic efficacy of a trigger reduction approach in this unique patient population. Methods: A retrospective chart review of patients seen between January 2011 and April 2018 for persistent dyspnea of unknown etiology was conducted. All patients failed to improve with treatment for presumptive diagnoses of allergy, asthma, sinus disease, and reflux. Patients were educated on our treatment protocol consisting of a Mediterranean style, plant-based diet with alkaline water, saline irrigation, and combined azelastine/fluticasone nasal spray. Treatment response was followed using two validated symptom questionnaires, Reflux Symptom Index (RSI) and Dyspnea Index (DI). Results: Of 57 initial patients, 8 were included in the final analysis. Mean age was 38.8 years (range 11-68). Six (75%) patients were female. All patients were followed for a minimum of 4 weeks. Using the reduction in DI and RSI as continuous variables to assess response, patients experienced a 9.4 (95% CI: 3.9-14.9) and 14.1 (95% CI: 6.0-22.2) mean point reduction, respectively. One patient saw a 100% and another a 95% reduction in DI. Six of eight patients experienced more than a 50% reduction in RSI. Conclusion: We hypothesize that Neurogenic Dyspnea is a newly described clinical phenomenon with a possible post-viral etiology. This pilot study demonstrated that our trigger reduction approach improved subjective symptoms in the majority of patients with unexplained dyspnea with previous treatment failure for common etiologies. Further studies are required to validate these findings.

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Section: Recent Reports Of Viral-associated Olfactory Loss Secondary Tomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurogenic Dyspnea: Is Idiopathic Dyspnea Related to a Post-Viral Sensory Neuropathy? A Case Series Supporting a New Hypothesis

Zalvan¹,

E1²,

Cole³

et al. 2021

AustinJOtolaryngol

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“…37 EILO/ILO is fairly common in the pediatric population as well, with as many as 30% of cases occurring in children. 17 Middle and high-school athletes are particularly at risk. [38][39][40][41] Although formal behavioral health testing in pediatric patients has not been widely reported, evidence suggests a high prevalence of behavioral health comorbidities in individuals with EILO/ILO.…”

Section: Introductionmentioning

confidence: 99%

“…14-16 Common symptom triggers include physical exertion, physical irritants, and/or emotional stressors. 12,17-19 When symptoms are induced by physical exertion, the term Exercise Induced Laryngeal Obstruction (EILO) is used. 20,21 Cases triggered by stress or environmental factors (such as exposure to strong smells or irritants including smoke, gasoline, or perfumes) are labeled as ILO.…”

Section: Introductionmentioning

confidence: 99%

Clinical Profiles of Children and Adolescents With Induced Laryngeal Obstruction (ILO) and Exercise Induced Laryngeal Obstruction (EILO)

Fujiki,

Olson-Greb,

Thibeault

2023

Ann Otol Rhinol Laryngol

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Purpose: To compare clinical profiles of pediatric patients with Induced Laryngeal Obstruction (ILO), Exercise Induced Laryngeal Obstruction (EILO), and EILO with non-exertion related secondary triggers (EILO+). Methods: A retrospective observational cohort design was employed. Four-hundred and twenty-three patients <18 years of age were identified from the electronic medical record of a large children’s hospital. All patients underwent evaluations with a laryngologist and speech-language pathologist and were diagnosed with EILO/ILO. Patients were divided into 3 groups based on dyspnea triggers reported in initial evaluations. Groups consisted of patients with EILO (N = 281), ILO (N = 30), and EILO+ (N = 112). Patient demographics, EILO/ILO symptoms, endoscopy findings, medical comorbidities, medical history, and EILO/ILO treatment information were extracted and compared across EILO/ILO subtypes. Results: Patients with EILO experienced higher rates of hyperventilation ( P < .001), sore throat ( P = .023), and chest pain ( P = .003). Patients with ILO were significantly younger in age ( P = .017) and presented with increased rates of nighttime symptoms ( P < .001), globus sensation ( P = .008), self-reported reflux symptoms ( P = .023), and history of gastrointestinal conditions ( P = .034). Patients with EILO+ were more likely to be female ( P = .037) and presented with higher prevalence of anxiety ( P = .003), ADHD ( P = .004), chest tightness ( P = .030), and cough ( P < .001). Conclusions: Patients with EILO, ILO, and EILO+ present with overlapping but unique clinical profiles. A prospective study is warranted to determine the etiology of these differences and clarify how the efficacy of EILO, ILO, and EILO+ treatment can be maximized. Level of Evidence: 4

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“…12,13 In addition, as many as 8% of adolescents experience ILO, 13,14 and pediatric patients account for approximately 30% of cases. 15 Research indicates that there is an association between ILO and behavioral health. [16][17][18] For example, 45 adult patients with ILO produced elevated scores on the hypochondriasis and hysteria sections of the Minnesota Multiphasic Personality Inventory, 19 suggesting that patients with ILO experience elevated health-related distress and/or anxiety related to physical symptoms.…”

mentioning

confidence: 99%

Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

Fujiki,

Thibeault

2024

JAMA Otolaryngol Head Neck Surg

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ImportancePatients with induced laryngeal obstruction (ILO) present with a variety of behavioral health profiles. Identifying these profiles is crucial in that behavioral health conditions may affect treatment duration and outcomes.ObjectiveTo characterize the prevalence of anxiety, depression, posttraumatic stress disorder (PTSD), and physical somatic symptoms in adult and pediatric patients with ILO and determine the factors associated with anxiety, depression, PTSD, and physical somatic symptoms in patients with ILO?Design, Setting, and ParticipantsThis cross-sectional study included a nonprobability sample of 83 adult and 81 pediatric patients diagnosed with ILO at outpatient adult and pediatric otolaryngology clinics between 2021 and 2023. Exclusion criteria included a comorbid respiratory diagnosis other than asthma, head or neck cancer, or neurological impairments. Recruitment took place between September 2021 and March 2023. The analyses were run in January 2024.Main Outcome MeasuresPatients were prospectively screened for anxiety, depression, PTSD, and somatic physical symptoms. In addition, any past behavioral health diagnoses were extracted from the medical record. Comorbidities, ILO symptoms triggers, and onset details were gathered from ILO evaluations. Adult patients completed the Screen for Adult Anxiety Related Disorders (SCAARED), depression (Patient Health Questionnaire [PHQ]-9), and somatic physical symptoms portions of the Patient Health Questionnaires (PHQ-15), and the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5). Pediatric patients completed the Screen for Child Anxiety Related Disorders (SCARED), depression (PHQ-9A) and somatic physical symptoms portions of the Patient Health Questionnaires for Adolescents (PHQ-15A), and the UCLA PTSD Reaction Index brief screeners.ResultsEighty-three adult patients participated in this study (mean [SD] age, 45.8 [14.3] years; 64 female, 19 male). Eighty-one pediatric patients participated (mean [SD] age, 13.83 [2.55] years; 67 female, 14 male). Adult and pediatric patients with ILO screened positive for elevated rates of anxiety (53 adults [63%]; 49 children [60%]), depression (27 adults [32%]; 25 children [30%]), and PTSD (29 adults [34%]; 13 children [16%]). Most of the patients with anxiety and depression symptoms were formally diagnosed prior to ILO evaluation, with rates of previously diagnosed anxiety, depression, and PTSD also above published norms. Adults were twice as likely as children to present with PTSD (odds ratio, 2.1; 95% CI, 0.05-4.48). Elevated rates of physical somatic symptoms were also evident, with 38 adults (45%) and 32 children (39%) scoring in the moderate to severe range.Conclusions and RelevanceThis study found high rates of adult and pediatric patients with ILO screened positive for anxiety, depression, and PTSD symptoms. Future work should investigate how behavioral health and ILO treatments can best be coordinated to maximize treatment outcomes.

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A Trigger Reduction Approach to Treatment of Paradoxical Vocal Fold Motion Disorder in the Pediatric Population

Cited by 11 publications

References 16 publications

Neurogenic Dyspnea: Is Idiopathic Dyspnea Related to a Post-Viral Sensory Neuropathy? A Case Series Supporting a New Hypothesis

Neurogenic Dyspnea: Is Idiopathic Dyspnea Related to a Post-Viral Sensory Neuropathy? A Case Series Supporting a New Hypothesis

Clinical Profiles of Children and Adolescents With Induced Laryngeal Obstruction (ILO) and Exercise Induced Laryngeal Obstruction (EILO)

Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

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