Trauma‐informed care improves management of paradoxical vocal fold movement patients

Abstract

Objectives: Vocal cord dysfunction (VCD) has been used by clinicians, primarily pulmonologists, to describe a variety of conditions in which the regulation and coordination of vocal fold movements are part of the explanation of cough or difficulty breathing, mainly paradoxical vocal fold motion disorder (PVFM). Prior studies show an intersection of mental health issues, primarily anxiety, and PVFM. We began incorporating mental health screening tools using the Life Events Checklist-5 (LEC-5) and the Posttraumatic Stress Disorder (PTSD) Checklist for Civilians (PCL-C) to assess symptomatology that may be related to traumatic life events. We seek to review the utility of these questionnaires for identifying patients who have experienced emotional trauma and use the principles of trauma-informed care currently lacking for PVFM.Methods: We incorporated mental health screening tools using the PCL-C and LEC-5 for anyone referred to the Chicago Institute for Voice Care for VCD from the pulmonology clinic at our institution. Each patient underwent a comprehensive strobovideolaryngoscopy including provocative maneuvers to provoke paradoxical movements.Results: A total of 16 subjects were analyzed; of those, seven (43.8%) screened positive for PTSD with the PCL-C. Overall, 58 traumatic events occurred among the 16 patients, with 31 (61.7%) of the traumatic events occurring in the seven positively screened for PTSD.Conclusions: Using the PCL-C and LEC-5, the principles of trauma-informed care principles were applied to patients initially referred for VCD who were found to have prior traumatic events. We recommend early mental health screening to establish a multidisciplinary team in PVFM.

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

“…Additionally, past study suggests that EILO/ILO treatment may improve when behavioral health comorbidities are addressed. 87,88 It is encouraging that speech therapy was equally effective across all EILO/ILO groups. 53 Findings indicated that 30% to 40% of patients were formally discharged from therapy with resolution of symptoms in their reported trigger conditions.…”

“…Additionally, past study suggests that EILO/ILO treatment may improve when behavioral health comorbidities are addressed. 87,88…”

Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

“…49 Preliminary study suggests that ILO is also associated with various behavioral health conditions; however, the nature and scope of these challenges have not been well understood. Considering the critical effect that behavioral health conditions have on treatment duration and outcomes, 22,24,50 further study of the mental health profiles of patients with ILO is warranted. The current study examined the prevalence of anxiety, depression, PTSD, and physical somatic symptoms in adult and pediatric patients with ILO.…”

“…Another study sampling 27 patients with ILO reported that 48% presented with anxiety and 11% with depression symptoms . Studies examining posttraumatic stress disorder (PTSD) in patients with ILO are less common; however, 43.8% of 16 patients with ILO screened positive for PTSD . An additional retrospective study reported a history of abuse in 38% of patients with ILO, suggesting that trauma could also be a consideration for this population.…”

“…[28][29][30] Most prospective studies are more than a decade old, and few have examined anxiety subtypes 16,17,19 or PTSD in this population. 22 The current study examined the prevalence of anxiety, depression, PTSD, and physical somatic symptoms in adult and pediatric patients with ILO. Based on past study, it was hypothesized that the prevalence of anxiety, PTSD, and somatic physical symptoms would be elevated in adults, and anxiety and somatic physical symptoms would be elevated in children.…”