Multi‐Institutional Study of Patient‐Reported Outcomes of Paradoxical Vocal Fold Motion

Abstract

Objective: To explore patient-reported outcome measures of pediatric paradoxical vocal fold motion through a multiinstitutional study of geographically diverse United States medical facilities to assess long-term management and outcomes.Methods: Eligible participants >8 years of age diagnosed with PVFM over a 10-year period from 7 tertiary pediatric hospitals were invited to complete a survey addressing study objectives.Results: 65 participants completed the survey, of whom 80% were female, 75% reported a 3.5 grade point average or better, and 75% identified as competitive athletes or extremely athletic individuals. Participants rated their perceived efficacy of 13 specific treatments. Only five treatments were considered effective by a majority of the participants who tried them. The treatments that participants tried most often were breathing exercises (89.2%), bronchodilator treatments (45%), and allergy medications (35.4%). 78.8% of participants reported receiving more than one treatment and 25% reported receiving a combination of bronchodilators, anticholinergics, and steroids. At the time of PVFM diagnosis, 38% of participants had no idea when their symptoms would completely resolve. 23.3% of participants did not experience symptom resolution until greater than 1 year after diagnosis.Conclusions: Traditional management tools such as breathing exercises and biofeedback treatments may not provide the long-term benefit that providers anticipate. In addition to these commonly used management strategies, highly efficacious techniques such as counseling and lifestyle management should be incorporated into the long-term management of patients whose symptoms are refractory to traditional care.

Patient perceptions of the impact of inducible laryngeal obstruction on quality of life

“…This includes the frustration, stigma, and burnout many patients with ILO experience and the potential for these factors to shape a patient’s perceived severity and outcomes. In both the broader medical/surgical literature, and literature specific to voice and ILO, there is evidence to suggest that common objective measures and clinician impression of treatment success and QOL may fail to account for important aspects of the patient perception of outcomes [ 22 – 24 ]. This work underscores the need for clinical care providers to engage in dialogue with patients that addresses significant elements of their perception of the disorder and how it impacts their lives.…”

Economic Burden of Induced Laryngeal Obstruction in Adolescents and Children

“…23 The primary treatment for ILO is respiratory retraining therapy with a speech-language pathologist (SLP). [35][36][37][38][39][40][41][42][43] The reduction of cost may reflect the efficacy of this intervention and subsequently reduced medical visits and pharmaceutical use. 44 A reduction in cost may also extend to pediatric patients, who undergo an average of 3.4 therapy sessions prior to discharge.…”

“…In adults, patients experienced fewer dyspnea‐related expenditures in the year following diagnosis than they did prior to diagnosis 23 . The primary treatment for ILO is respiratory retraining therapy with a speech‐language pathologist (SLP) 35–43 . The reduction of cost may reflect the efficacy of this intervention and subsequently reduced medical visits and pharmaceutical use 44 .…”

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

“…For example, EILO/ILO/EILO+ symptoms frequently resolve quickly when triggers are removed, 2,46 making symptom trigger identification a key component of diagnosis and treatment. 12,47,48 Although numerous treatments have been reported in the literature, 27,[49][50][51][52] therapy with a speech-language pathologist (SLP) is the primary treatment for EILO/ILO/EILO+. 53 Speech therapy addressing EILO/ILO/EILO+ is comprised of education regarding the condition, rescue techniques, and application of these techniques.…”

“…Although numerous treatments have been reported in the literature, 27,49-52 therapy with a speech-language pathologist (SLP) is the primary treatment for EILO/ILO/EILO+. 53 Speech therapy addressing EILO/ILO/EILO+ is comprised of education regarding the condition, rescue techniques, and application of these techniques.…”