Abstract
Background: Paradoxical vocal cord dysfunction (pVCD) is a debilitating condition caused by inappropriate vocal cord motion. Exercise testing with laryngoscopy followed by therapy is the accepted management of adults with pVCD but little evidence is available on the use of this method with children.
Aim: To determine the efficacy of pre and post exercise flexible awake laryngoscopy in the diagnosis and treatment of children with paradoxical vocal cord dysfunction (pVCD).
Methods: 10 boys and 5 girls with a provisional diagnosis of pVCD were assessed in a specialist multidisciplinary environment. Each child underwent an awake flexible fibreoptic laryngoscopy before and after a treadmill based exercise test to trigger an acute episode. Treatment involved breathing retraining and other associated techniques delivered by an experienced physiotherapist.
Results: All patients tolerated the procedure well and 11 of the 15 children had abnormal cord motion post exercise (73%). 3 of these children also had abnormal cord motion at rest prior to exercise(27%). 12 chose to undertake a course of treatment. 7 children completed the course of treatment, 2 didn't attend for treatment and 3 are on the waiting list.
Using the PedsQL health related quality of life (QoL) measure, 80% of children and 100% of parents reported a significant improvement in QoL. Mean QoL scores for children and parents improved by 10 points. Post treatment, all children were either asymptomatic or experiencing minor symptoms which did not limit their activity.
Conclusion: Exercise laryngoscopy is a well tolerated and effective means of diagnosing pVCD. When the diagnosis is made, response to breathing retraining therapy is excellent.
- Copyright ©ERS 2015