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Outcomes of Paradoxical Vocal Cord Motion Diagnosed in Childhood.
Ann Otol Rhinol Laryngol. 2020 Jun 12 [Online ahead of print]AO

Abstract

OBJECTIVES

To explore long-term patient reported outcome (PRO) measures of pediatric paradoxical vocal cord motion (PVCM) including ease of diagnosis, management, symptom duration and effect on quality of life.

METHODS

All children >8 years of age diagnosed with PVCM at a tertiary pediatric hospital between 2006 and 2017 were invited to complete a survey addressing study objectives.

RESULTS

21/47 eligible participants could be contacted and 18/21 (86%) participated. 78% were female with a mean age at diagnosis of 11.6 and 15.0 years at survey completion. Common PVCM symptoms reported were dyspnea (89%), globus sensation (56%), and stridor (50%). The median time to diagnosis was 3 months (IQR 2-5 months). Nearly all reported being misdiagnosed with another condition, usually asthma, until being correctly diagnosed usually by an otolaryngologist. Participants reported undergoing 3.7 diagnostic studies (range 0-8); pulmonary function testing was most common. Of numerous treatments acknowledged, breathing exercises were common (89%) but only reported helpful by 56%. Use of biofeedback was recalled in 1/3 of subjects but reported helpful in only 14% of them. Anti-reflux, allergy, anticholinergics, inhalers and steroids were each used in >50%, but rarely reported effective. PVCM was reportedly a significant stressor when initially diagnosed but despite 2/3 of participants still reporting ongoing PVCM symptoms, the perceived stress significantly decreased over time (Z = 3.26, P = 0.001).

CONCLUSIONS

This first PVCM PRO study endorses that diagnosis is often delayed and prescribed treatments often viewed as ineffective. While biofeedback and breathing exercises may be critical for short-term control of PVCM episodes, lifestyle changes and stress reduction are likely necessary for long-term management. Increased awareness and improvements in management are needed for this condition.

Authors+Show Affiliations

The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Children's National Hospital, Washington, DC, USA.Children's National Hospital, Washington, DC, USA.The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Children's National Hospital, Washington, DC, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32527140

Citation

Yibrehu, Betel, et al. "Outcomes of Paradoxical Vocal Cord Motion Diagnosed in Childhood." The Annals of Otology, Rhinology, and Laryngology, 2020, p. 3489420931894.
Yibrehu B, Georgakopoulos B, Mudd PA, et al. Outcomes of Paradoxical Vocal Cord Motion Diagnosed in Childhood. Ann Otol Rhinol Laryngol. 2020.
Yibrehu, B., Georgakopoulos, B., Mudd, P. A., Rana, M. S., & Bauman, N. M. (2020). Outcomes of Paradoxical Vocal Cord Motion Diagnosed in Childhood. The Annals of Otology, Rhinology, and Laryngology, 3489420931894. https://doi.org/10.1177/0003489420931894
Yibrehu B, et al. Outcomes of Paradoxical Vocal Cord Motion Diagnosed in Childhood. Ann Otol Rhinol Laryngol. 2020 Jun 12;3489420931894. PubMed PMID: 32527140.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of Paradoxical Vocal Cord Motion Diagnosed in Childhood. AU - Yibrehu,Betel, AU - Georgakopoulos,Bianca, AU - Mudd,Pamela A, AU - Rana,Md Sohel, AU - Bauman,Nancy M, Y1 - 2020/06/12/ PY - 2020/6/13/entrez KW - paradoxical vocal cord dysfunction KW - paradoxical vocal cord motion KW - pediatrics KW - vocal cord dysfunction SP - 3489420931894 EP - 3489420931894 JF - The Annals of otology, rhinology, and laryngology JO - Ann. Otol. Rhinol. Laryngol. N2 - OBJECTIVES: To explore long-term patient reported outcome (PRO) measures of pediatric paradoxical vocal cord motion (PVCM) including ease of diagnosis, management, symptom duration and effect on quality of life. METHODS: All children >8 years of age diagnosed with PVCM at a tertiary pediatric hospital between 2006 and 2017 were invited to complete a survey addressing study objectives. RESULTS: 21/47 eligible participants could be contacted and 18/21 (86%) participated. 78% were female with a mean age at diagnosis of 11.6 and 15.0 years at survey completion. Common PVCM symptoms reported were dyspnea (89%), globus sensation (56%), and stridor (50%). The median time to diagnosis was 3 months (IQR 2-5 months). Nearly all reported being misdiagnosed with another condition, usually asthma, until being correctly diagnosed usually by an otolaryngologist. Participants reported undergoing 3.7 diagnostic studies (range 0-8); pulmonary function testing was most common. Of numerous treatments acknowledged, breathing exercises were common (89%) but only reported helpful by 56%. Use of biofeedback was recalled in 1/3 of subjects but reported helpful in only 14% of them. Anti-reflux, allergy, anticholinergics, inhalers and steroids were each used in >50%, but rarely reported effective. PVCM was reportedly a significant stressor when initially diagnosed but despite 2/3 of participants still reporting ongoing PVCM symptoms, the perceived stress significantly decreased over time (Z = 3.26, P = 0.001). CONCLUSIONS: This first PVCM PRO study endorses that diagnosis is often delayed and prescribed treatments often viewed as ineffective. While biofeedback and breathing exercises may be critical for short-term control of PVCM episodes, lifestyle changes and stress reduction are likely necessary for long-term management. Increased awareness and improvements in management are needed for this condition. SN - 1943-572X UR - https://www.unboundmedicine.com/medline/citation/32527140/Outcomes_of_Paradoxical_Vocal_Cord_Motion_Diagnosed_in_Childhood L2 - https://journals.sagepub.com/doi/10.1177/0003489420931894?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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