Respiratory Retraining Therapy in Long-Term Treatment of Paradoxical Vocal Fold Dysfunction

Nacci, Andrea; Fattori, Bruno; Segnini, G; Dallan, Iacopo; Panicucci, Erica; Rocchi, Valeria; Ursino, Francesco

doi:10.1159/000316405

Cited by 23 publications

(28 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We know for example, that muscle strength is reversible and changes over time [21]. One may speculate that repeated training sessions would contribute to maintenance of the positive short-term results obtained after IBA + IMT as reported when applied in patients with paradoxical vocal fold motion at rest [45]. This should be investigated in future controlled studies.…”

Section: Information and Breathing Advice Versus Inspiratory Muscle Trainingmentioning

confidence: 93%

Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

Sandnes

Andersen

Clemm

et al. 2021

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose Exercise-induced laryngeal obstruction (EILO) is relatively common in young people. Treatment rests on poor evidence; however, inspiratory muscle training (IMT) has been proposed a promising strategy. We aimed to assess laryngeal outcomes shortly after IMT, and to compare self-reported symptoms with a control group 4–6 years later. Methods Two groups were retrospectively identified from the EILO-register at Haukeland University Hospital, Norway; one group had received only information and breathing advice (IBA), and another additionally IMT (IBA + IMT). At diagnosis, all participants performed continuous laryngoscopy during exercise (CLE), with findings split by glottic and supraglottic scores, and completed a questionnaire mapping exercise-related symptoms. After 2–4 weeks, the IBA + IMT-group was re-evaluated with CLE-test. After 4–6 years, both groups were re-assessed with a questionnaire. Results We identified 116 eligible patients from the EILO-register. Response rates after 4–6 years were 23/58 (40%) and 32/58 (55%) in the IBA and IBA + IMT-group, respectively. At diagnosis, both groups rated symptoms similarly, but laryngeal scores were higher in the IBA + IMT-group (P = 0.003). After 2–4 weeks, 23/32 in the IBA + IMT-group reported symptom improvements, associated with a decrease of mainly glottic scores (1.7–0.3; P < 0.001), contrasting unchanged scores in the 9/32 without symptom improvements. After 4–6 years, exercise-related symptoms and activity levels had decreased to similar levels in both groups, with no added benefit from IMT; however, full symptom resolution was reported by only 8/55 participants. Conclusion Self-reported EILO symptoms had improved after 4–6 years, irrespective of initial treatment. Full symptom resolution was rare, suggesting individual follow-up should be offered.

show abstract

Section: Information and Breathing Advice Versus Inspiratory Muscle Trainingmentioning

confidence: 93%

Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

Sandnes

Andersen

Clemm

et al. 2021

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…or reduce tension at the level of the larynx and supraglottic structures 4,18 that occurred as a result of VCD. Psychoeducational counselling was a key feature.…”

Section: Glottic Airway and Respiratory Retrainingmentioning

confidence: 99%

Treatment effectiveness for Vocal Cord Dysfunction in adults and adolescents: A systematic review

Mahoney

Hew

Vertigan

et al. 2021

Clin Experimental Allergy

View full text Add to dashboard Cite

Objective: To determine whether treatment effectiveness can be established for a range of vocal cord dysfunction (VCD) interventions in adolescents and adults.Design: A systematic review of the literature and risk of bias appraisal was completed using the Joanna Briggs Institute Critical Appraisal Tools. Data were qualitatively synthesized in the broad intervention groups of glottic airway and respiratory retraining, pharmacological therapies, airway device therapies and psychological therapies.Data sources: Nine electronic databases, two clinical trial registries and the grey literature were searched from inception to September 2021 for articles on VCD interventions or equivalent terms.Eligibility criteria: Studies were included if they were randomized controlled trials, non-randomized controlled trials, quasi-experimental pre-and post-test studies and within-subject repeated measure designs, participants were 13 years or older, VCD was diagnosed using laryngoscopy or CT larynx, VCD intervention was provided and outcome measures reported on VCD symptoms. Results:The search yielded no randomized controlled trials. There were 17 quasiexperimental studies that met the eligibility criteria, and these studies reported on glottic airway and respiratory retraining, botulinum toxin injections, inspiratory muscle strength training and amitriptyline; all were associated with VCD symptom reduction. In addition, 2 within-subject repeated measure studies reported inspiratory muscle strength training and respiratory retraining to be effective in reducing symptoms in participants with exertional VCD. The included studies were reported in fulltext publications (11) and conference proceedings (8). There was a high risk of bias and low quality of evidence across all intervention areas. Conclusion: Glottic airway and respiratory retraining, botulinum toxin injections, lowdose amitriptyline and inspiratory muscle strength training devices have been associated with symptom reduction in adults and adolescents with vocal cord dysfunction. Limited objective data exist to support the effectiveness of these interventions, and robust controlled trials are needed in this area.

show abstract

“…There is also some evidence that, for some adults with PVFM, multiple treatment sessions over a longer time period may be beneficial. Nacci et al [37] compared outcomes in two groups of patients who received treatment in two different schedules over the course of 2 years. In perhaps the most intensive therapy program described in the literature, the treatment program began with sessions for 5 consecutive days a week for 3 weeks (for a total 15 sessions), followed by follow-up therapy given for 5 consecutive days a week for 2 weeks (for a total of 10 sessions).…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults

Drake

Palmer

Schindler

et al. 2017

Folia Phoniatr Logop

View full text Add to dashboard Cite

Objective: Paradoxical vocal fold motion (PVFM) is responsive to behavioral therapy, often resulting in a remission of symptoms, but little is known about whether treatment is beneficial with regard to PVFM-associated psychological symptoms or functional limitations. The goal of the study was to identify patient perceptions of the impact of treatment for PVFM and characteristics associated with treatment outcomes. Methods: A survey was conducted of all adults who had received at least 1 session of treatment for PVFM in our outpatient clinic over a 2-year period. Results: The 39 participants ranged in age from 18 to 82 and had received a median of 3 treatment sessions. At a median follow-up of 10 months following treatment, respondents reported improvements in a wide range of areas, including sports and leisure, daily activities, and social participation. The majority reported improvements in feelings of anxiety, helplessness, and control. Poorer outcomes were associated with more severe voice symptoms, fewer treatment sessions, and needing oral steroids for asthma control. Conclusion: There was a reduction in a wide range of activity limitations after treatment. Feelings of control were strongly associated with positive outcomes. The therapy appeared to be equally effective for adults with exercise-induced and environmental variants of PVFM.

show abstract

Respiratory Retraining Therapy in Long-Term Treatment of Paradoxical Vocal Fold Dysfunction

Cited by 23 publications

References 61 publications

Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

Treatment effectiveness for Vocal Cord Dysfunction in adults and adolescents: A systematic review

Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults

Contact Info

Product

Resources

About