The Association between Paradoxical Vocal Fold Motion and Dysphonia in Adolescents

Abstract

Objective: Associations between dysphonia and paradoxical vocal fold motion (PVFM) have been previously reported in adults, but it is unclear whether similar associations exist for adolescents. The goals of this study were to identify the prevalence and severity of voice disorders in adolescent patients with PVFM, identify differences between those with and without clinician-identified dysphonia, and investigate what factors were associated with voice handicap in this population. Methods: A retrospective review of eligible adolescent patients diagnosed with PVFM over a 1-year period at a single institution was undertaken. Data collected from the medical record included demographic background, medical history and workup, patient-and family-reported symptoms, and findings from the laryngeal examination. The presence or absence of clinician-diagnosed dysphonia was used to subdivide the sample for analysis. Results: Forty-eight patients with PVFM were included. The sample was primarily female (73%) with a median age of 15 years. Few patients had voice complaints (5%), but clinician-diagnosed dysphonia was common (52%) and ranged from mild to moderate. Vocal hyperfunction was frequently observed (55%), but anatomic abnormalities associated with dysphonia were rare (6%). Adolescents with dysphonia were significantly older, more likely to have vocal hyperfunction on laryngoscopy, and more likely to return for therapy than those without dysphonia. No notable differences existed in the number of behavioral therapy sessions or in the likelihood of completing treatment between the two groups. The majority of participants (79%) had at least one "confounding factor" (i.e., were currently taking a medication for asthma, allergies, or reflux, or had a laryngeal abnormality) but this did not differ significantly between those with and without dysphonia. A minority of individuals (28%) had abnormal scores on the Voice Handicap Index (VHI). Age was positively correlated with dysphonia severity but no other significant associations were observed. Conclusion: Although voice complaints are rare, dysphonia among adolescents with PVFM is common and can occur in the absence of laryngeal abnormalities and medical comorbidities, typically as a result of vocal hyperfunction. Dysphonia does not appear to be a barrier to PVFM treatment and may be a useful target in therapy.

The impact of identifying laryngeal obstruction syndromes on reducing treatment of pediatric asthma: A systematic review

“…A total of 1559 references were identified through database searching and 11 additional through reference reviews. After removing duplicates and identifying records from other sources (reference lists of reviews), the titles and abstracts of 1076 studies were screened for relevance, and 31 studies were selected for full‐text review for eligibility, resulting in the inclusion of eight cohort studies: one retrospective chart review, one prospective, and six observational cohort studies 22–29 . No randomized controlled trials (RCTs) were identified.…”

“…In two studies, one showed probably the high risk of bias for all domains except detection (probably low risk) 23 ; the other showed probably the low risk of bias for all domains except participant selection and attrition/exclusion (probably high risk). 26 Due to the descriptive nature, small patient numbers, limited recruitment strategies, and reliance on retrospective data with or without a follow-up, all studies had a high risk of bias.…”

“…After removing duplicates and identifying records from other sources (reference lists of reviews), the titles and abstracts of 1076 studies were screened for relevance, and 31 studies were selected for fulltext review for eligibility, resulting in the inclusion of eight cohort studies: one retrospective chart review, one prospective, and six observational cohort studies. [22][23][24][25][26][27][28][29] No randomized controlled trials (RCTs) were identified. Eight case studies were identified but excluded from the analysis.…”

“…Laryngoscopy, the gold standard, 30 22 Rameau et al 25 Sullivan et al 26 Vance et al 27 No formal therapy (%) T A B L E 3 Summarized characteristics of patients with a suspected asthma diagnosis before evaluation for ILO from each of the included studies Doshi et al 22 Fulton et al 23 Hseu et al 24 Rameau et al 25 Sullivan et al 26 Vance et al 27 Yibrehu et al 28 Ivancic et al 29 Trend The GRADE method was used to summarize the evidence for interventions (Table 4). 21 There is moderate certainty of evidence that SLP and/or behavioral therapy provide improvement in symptoms, [22][23][24][25][26][27][28][29] and a very low certainty of evidence supporting an anticholinergic inhaler 22,24 or Botox therapy 27 to improve symptoms.…”

“…34,35 Several studies reported comorbidity including GERD. Laryngopharyngeal reflux may increase laryngeal inflammation, and ILO pathophysiology may contribute to GERD symptoms in some T A B L E 3 (Continued) Doshi et al 22 Fulton et al 23 Hseu et al 24 Rameau et al 25 Sullivan et al 26 Vance et al 27 Yibrehu et al 28 Ivancic et al 29 patients. 30 The proposed mechanism is through increased negative intrathoracic pressure generated during work of breathing with ILO overcoming esophageal opening pressure.…”