Comparative analysis of clinical profile: Chronic cough vs paradoxical vocal fold motion

Abstract

Background Ongoing contention surrounding typical demographic and clinical attributes of chronic cough (CC) and paradoxical vocal fold motion (PVFM) impedes timely diagnosis and optimum patient care. Designed to reduce preventable patient morbidity through improved recognition and differentiation, the current study aimed to determine representative clinical profiles for CC and PVFM, with identification of distinctive attributes from the general population and risk factors associated with each diagnosis. Methods Self-reported medical questionnaires, demographic and lifestyle attributes of CC and PVFM cases from a disease-specific outcomes database were compared to US population data and published normative values. Univariate comparison and multivariate regression modelling of age, sex, alcohol intake, smoking, Reflux Symptom Index (RSI), Voice Handicap Index (VHI), and Generalized Anxiety Disorder 7-item Scale (GAD-7) determined distinguishing features between the clinical groups, including odds ratios for presenting with CC versus PVFM. Results Clinical profiles developed from 283 (128 CC, 155 PVFM) adults (18–91years) were significantly different from the general population across each demographic, lifestyle and clinical variable (all p<.01), with the exception of obesity. Age (55.39 ± 13.54 vs 45.07 ± 16.51years, p<.01) and mean RSI score (21.5 ±9.02 vs 18.1±9.08, p<.01) most reliably distinguished CC from PVFM, with those aged 60–69 years (OR=9.45) most likely to be diagnosed with CC. Conclusions Standard clinical profiles of CC and PVFM are distinct from the general population, aiding determination of relative probabilities and risk factors in the differential diagnostic process. Variations between CC and PVFM were subtle, reliably distinguished by age and relative severity of laryngopharyngeal reflux symptomatology.

The Association between Paradoxical Vocal Fold Motion and Dysphonia in Adolescents

“…In a study by Hartley et al[29], 77% of their adult patients with PVFM had VHI scores within the normal range, which is comparable to 72% for our sample. The mean score of 15.0 on the VHI in our study is slightly lower than the values of 17.8–27.3 reported for adults with PVFM in previous studies [29-31], and it is also slightly lower than the mean of 20 reported by de Bodt et al[32] in a pediatric cohort with vocal fold nodules. Comparing our scores on the pVHI to those reported in the original validation study [14], the mean score in our group (4.5) was higher than that reported for non-dysphonic controls (mean = 1.8) but considerably lower than that of a severely dysphonic population (mean = 41.6) which included children with subglottic stenosis and laryngotracheal reconstruction.…”

“…No other previous studies have used the VHI or the pVHI in adolescents with PVFM, as far as we are aware. The VHI has previously been used to assess voice handicap in adults with PVFM [7, 29, 30]. In a study by Hartley et al[29], 77% of their adult patients with PVFM had VHI scores within the normal range, which is comparable to 72% for our sample.…”

“…The VHI has previously been used to assess voice handicap in adults with PVFM [7, 29, 30]. In a study by Hartley et al[29], 77% of their adult patients with PVFM had VHI scores within the normal range, which is comparable to 72% for our sample. The mean score of 15.0 on the VHI in our study is slightly lower than the values of 17.8–27.3 reported for adults with PVFM in previous studies [29-31], and it is also slightly lower than the mean of 20 reported by de Bodt et al[32] in a pediatric cohort with vocal fold nodules.…”

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

“…Consequently, the current findings require confirmation from a prospective longitudinal study and provide justification for this type of investigation using validated measures of general health, dyspnea severity, and psychological well-being. Recent research has shown that adults with PVFM have higher levels of anxiety compared to the general population using a published, validated scale [46]. In addition to these measures, there are now some newer scales validated for use with PVFM, such as the Dyspnea Index [47] and the Vocal Cord Dysfunction Questionnaire [48] which could be used in conjunction with participation or quality of life measures in future research to document the efficacy of treatment, risk factors for poorer outcomes, and levels of satisfaction with the effects of intervention.…”

Risk factors for chronic cough in adults: A systematic review and meta‐analysis

“…Findings of such studies are subject to multiple biases. [16][17][18][19][20] Few population-based studies have investigated risk factors for chronic cough longitudinally 12,[21][22][23][24] and their findings have not yet been systematically synthesized. Such a synthesis would extend understanding of the pathophysiological mechanisms, potential treatments and avenues for prevention for chronic cough.…”