Does treatment of paradoxical vocal fold movement disorder decrease asthma medication use?

Kramer, Scott; deSilva, Brad W.; Forrest, L. Arick; Matrka, Laura

doi:10.1002/lary.26416

Cited by 30 publications

(44 citation statements)

References 14 publications

(20 reference statements)

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“…Forrest et al proposed that PVFMD is a descriptive term that is multifactorial and the etiology should direct treatment 7. They proposed a classification scheme that divides PVFMD into primary (75%), which is psychological, and secondary (25%), which consists of medical disorders divided into irritable larynx syndrome and neurologic disorder 8. Typical episodes of PVFMD last from seconds to minutes and occur primarily but not exclusively during inspiration.…”

Section: Introductionmentioning

confidence: 99%

“…However, PVFMD may not be seen on examination, largely because it is intermittent and it can be difficult to conduct laryngoscopy examination in the middle of an acute attack because of patient distress 3. It has been suggested that laryngoscopy examination is invasive, uncomfortable, and may interfere with normal laryngeal function or even induce PVFMD 8. Nevertheless, until correlates of laryngeal closure are determined or noninvasive methods of inspecting the larynx are discovered, laryngoscopy remains the primary diagnostic tool 8.…”

Section: Introductionmentioning

confidence: 99%

“…It has been suggested that laryngoscopy examination is invasive, uncomfortable, and may interfere with normal laryngeal function or even induce PVFMD 8. Nevertheless, until correlates of laryngeal closure are determined or noninvasive methods of inspecting the larynx are discovered, laryngoscopy remains the primary diagnostic tool 8. Thus, to diagnose PVFMD, we propose performing transnasal laryngoscopy examination and applying The Pittsburgh Vocal Cord Dysfunction Index 4.…”

Section: Introductionmentioning

confidence: 99%

“…Once diagnosis is confirmed, treatment should then be directed at acutely relieving airway obstruction 2. The first step is to reassure the patients that this condition is benign and that their oxygen levels are normal despite the severe dyspnea, while calmly quashing their fears 8. Kramer et al found that by educating and showing the patient normal vocal fold movements during respiration, followed by their own laryngoscopic video recordings with evidence of constriction during respiration, is often helpful 8.…”

Section: Introductionmentioning

confidence: 99%

“…The first step is to reassure the patients that this condition is benign and that their oxygen levels are normal despite the severe dyspnea, while calmly quashing their fears 8. Kramer et al found that by educating and showing the patient normal vocal fold movements during respiration, followed by their own laryngoscopic video recordings with evidence of constriction during respiration, is often helpful 8. Morris et al found ample evidence of the effectiveness of relieving acute airway symptoms with reassurance alone 9.…”

Section: Introductionmentioning

confidence: 99%

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The forgotten cause of stridor in the emergency department

2017

OAEM

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Paradoxical Vocal Fold Movement Disorder is where the larynx exhibits paradoxical vocal cords closure during respiration, creating partial airway obstruction. Causes of vocal fold movement disorder are multifactorial, and patients describe tightness of throat, difficulty getting air in, have stridor, and do not respond to inhalers. We propose using transnasal laryngoscopy examination, which will show narrowing of vocal cords on inspiration, and The Pittsburgh Vocal Cord Dysfunction Index with a cutoff score of ≥4 to distinguish vocal fold movement disorder from asthma and other causes of stridor. Management of paradoxical vocal fold movement disorder involves a combination of pharmacological, psychological, psychiatric, and speech training. Paradoxical vocal fold movement disorder is a very treatable cause of stridor, so long as it is identified and other organic causes are excluded.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The forgotten cause of stridor in the emergency department

2017

OAEM

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Vocal fold botulinum toxin injection for refractory paradoxical vocal fold motion disorder

et al. 2018

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Objective Demonstrate efficacy of vocal fold botulinum toxin injection for treatment of refractory paradoxical vocal fold motion disorder (PVFMD). Methods A retrospective review was completed of patients diagnosed with PVFMD who underwent vocal fold botulinum toxin injection for dyspnea symptoms that persisted despite laryngeal control therapy, medical management, and biofeedback therapy. Outcomes measured included overall improvement and resolution of dyspnea symptoms, number of botulinum toxin injections and dose range, change in dyspnea severity index (DSI) scores, and adverse effects of injection therapy. Results Thirteen patients (9 female/4 male) underwent vocal fold botulinum toxin injection for refractory PVFMD. The average dose was 2.55 units per vocal fold (range 1.75–5.5 units). The average number of injections was 3.85 (range 1–12 injections). Eleven of 13 (84.6%) patients experienced improvement in dyspnea symptoms, with two of 11 (18.2%) having complete resolution of symptoms. There was a statistically significant improvement in DSI scores because the mean preinjection DSI was 30.43 and improved to 17.43 postinjection (P = 0.017). Temporary breathy voice quality was experienced by all patients with no other adverse side effects. Conclusion Vocal fold botulinum toxin injection is a safe and effective treatment option for PVFMD and should be considered in patients with refractory dyspnea symptoms following appropriate medical therapy and respiratory retraining protocols. Level of Evidence 4 Laryngoscope, 129:808–811, 2019

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Reduced Asthma Medication Use after Treatment of Pediatric Paradoxical Vocal Fold Motion Disorder

et al. 2020

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Objectives/Hypotheses: The primary objective of this study was to determine whether the diagnosis and treatment of pediatric Paradoxical Vocal Fold Motion Disorder (PVFMD) leads to decreased asthma medication use. Our secondary objective was to determine dyspnea outcomes following diagnosis and treatment for PVFMD.Study Design: Prospective observational study. Methods: Patients with newly diagnosed PVFMD between the ages of 11 and 17 were recruited at a single pediatric institution. A medication questionnaire and Dyspnea Index (DI) were completed at the initial visit, at the first return visit, and at greater than 6 months post-diagnosis and therapy. Laryngeal Control Therapy (LCT) consisted of teaching breathing techniques and identifying emotional, physical, and environmental contributing factors and strategies to reduce them.Results: Twenty-six patients were recruited to the study. There were 19/26 (73%) patients diagnosed with asthma prior to a diagnosis of PVFMD, and 26/26 (100%) patients were using an inhaler prior to the enrollment visit. Twenty-two (85%) patients completed follow-up questionnaires. Five patients participated in no therapy, seven patients in partial therapy, and 14 patients in full therapy. Significant reduction in asthma medication use was seen in the full therapy group (P < .05) and in those with exercise as their only trigger (P < .05). Furthermore, symptoms as scored by the DI decreased overall from 25.5 to 18.8 (P < .001).Conclusions: Diagnosis and treatment of pediatric PVFMD leads to a decline in asthma medication use in those patients who participate in at least two LCT sessions and in those with exercise-induced PVFMD. LCT for pediatric PVFMD leads to a significant decrease in symptoms as measured by the DI.

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Does treatment of paradoxical vocal fold movement disorder decrease asthma medication use?

Abstract: 4. Laryngoscope, 127:1531-1537, 2017.

Cited by 30 publications

References 14 publications

The forgotten cause of stridor in the emergency department

The forgotten cause of stridor in the emergency department

Vocal fold botulinum toxin injection for refractory paradoxical vocal fold motion disorder

Reduced Asthma Medication Use after Treatment of Pediatric Paradoxical Vocal Fold Motion Disorder

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