Controversies and conundrums in vocal cord dysfunction

Bardin, Philip G.; Low, Kathy A.; Ruane, Laurence; Lau, Kenneth

doi:10.1016/s2213-2600(17)30221-7

Cited by 27 publications

(15 citation statements)

References 9 publications

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“…These include the intermittent nature of the condition, difficulties to gain access to laryngoscopy during symptomatic periods, VCD induced only by exercise or other factors and inability to quantify severity of VCD . We have developed dynamic CT larynx to diagnose and quantify VCD but it has similar drawbacks, involves exposure to ionizing radiation and remains chiefly a research tool . Treatment of VCD is problematic as LR with speech pathology, used as initial treatment, has never been validated in a randomized trial.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary team clinic for vocal cord dysfunction directs therapy and significantly reduces healthcare utilization

et al. 2019

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Background and objective: Multidisciplinary team (MDT) clinics use an integrated approach to individualize care of complex medical conditions. Vocal cord dysfunction (VCD) is a challenging condition that is likely to benefit from MDT clinics but this has not been researched. Methods: A prospective observational cohort study of a novel VCD MDT clinic was conducted in patients with suspected VCD. Relevant questionnaires, medical history, physical examination, spirometry, dynamic computerized tomography (CT) larynx and laryngoscopy were utilized and patients were allocated to treatment pathways depending on putative diagnosis. Speech pathology intervention with laryngeal retraining (LR) was offered and if LR therapy failed botulinum toxin injection was offered. Primary outcome was reductions in healthcare utilization. Results: Overall, 80 consecutive patients were included in analyses. A definitive diagnosis of VCD was made in 56 of 80 (70%) patients. After LR (n = 35), emergency department (ED)/hospital admissions declined significantly in the subsequent 12 months (P = 0.001). General practice visits also reduced (P < 0.001). Botulinum toxin injections were administered in 21 patients unresponsive to LR therapy and both general practice and ED/hospital visits declined (P < 0.001 and P = 0.01, respectively) after injection. Conclusion: A multidisciplinary approach to VCD confers benefit and can be used to allocate appropriate management leading to a reduction in healthcare utilization. SUMMARY AT A GLANCEMultidisciplinary team (MDT) clinics use an integrated approach and individualized services that may benefit vocal cord dysfunction (VCD). We show that a VCD MDT clinic can be used to allocate appropriate management leading to a reduction in healthcare utilization.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary team clinic for vocal cord dysfunction directs therapy and significantly reduces healthcare utilization

et al. 2019

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“…It is now over 30 years since the first description that paradoxical (i.e., inspiratory phase) glottic closure could act to precipitate symptoms mimicking asthma . Since that time, there has been an evolving appreciation of the role of laryngeal closure in causing difficult‐to‐treat respiratory symptoms both in general and in workplace environments . Despite this, progress with respect to our understanding of the mechanisms ILO, variable characteristics and responses to intervention have been hampered by the lack of a valid, robust diagnostic methodology .…”

Section: Discussionmentioning

confidence: 99%

“…15 Since that time, there has been an evolving appreciation of the role of laryngeal closure in causing difficult-to-treat respiratory symptoms both in general and in workplace environments. 16,17 Despite this, progress with respect to our understanding of the mechanisms ILO, variable characteristics and responses to intervention have been hampered by the lack of a valid, robust diagnostic methodology. 4 The recent promotion of CLE to establish a robust diagnosis of EILO has facilitated considerable advances in our understanding of differing clinical phenotypes, 18 response to treatments that include biofeedback, 10 and surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

et al. 2018

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“…These verified grading systems all involve subjective decision making, and their reproducibility has been questioned . Objective outcome measures are needed to disentangle diagnostic confusions between EILO, EIB, and asthma, and to improve clinical decision making in relation to treatment of EILO, especially for cases where irreversible surgery is being considered.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and tolerability of measuring translaryngeal pressure during exercise

et al. 2019

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Objectives/HypothesisTo determine if simultaneous tracheal and supraglottic pressure measurement performed during a continuous laryngoscopy exercise (CLE) test is possible, tolerable, and feasible, and if so, whether measurements can be used to determined airflow resistance over the larynx, thus providing an objective outcome measure for the CLE test, the gold standard for diagnosing exercise‐induced laryngeal obstruction.Study DesignExplorative descriptive clinical study.MethodsA CLE test was performed with the addition of two pressure sensors (Mikro‐Cath 825‐0101; Millar, Houston, TX) placed at the epiglottic tip and at the fifth tracheal ring. To place sensors, laryngeal anesthesia and a channel scope were required. Tolerability and feasibility was determined by a Likert score and subjective indication from subjects and operators. Adjustments to the technique were made to increase tolerability. The pressure data were continuously collected and analyzed for artifacts, drifts, frequency response, and used with flow data to calculate translaryngeal resistance.ResultsAll subjects (n = 7) completed all procedures. Two main areas of concern were identified regarding tolerability: application of topical anesthesia to the larynx and nasal discomfort due to the added diameter of the laryngoscope. Protocol adjustments improved both. Pressure data were obtained from all procedures in all subjects, were consistent, and followed physiological trends.ConclusionsContinuous measurement of the translaryngeal pressure gradient during a CLE test is possible, feasible, and tolerable. A CLE test with direct measurement of the translaryngeal pressure gradient might become a valuable tool in the objective assessment of respiratory function, and normal values should be established in health and disease.Level of EvidenceNA Laryngoscope, 129:2748–2753, 2019

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Controversies and conundrums in vocal cord dysfunction

Cited by 27 publications

References 9 publications

Multidisciplinary team clinic for vocal cord dysfunction directs therapy and significantly reduces healthcare utilization

Multidisciplinary team clinic for vocal cord dysfunction directs therapy and significantly reduces healthcare utilization

Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

Feasibility and tolerability of measuring translaryngeal pressure during exercise

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