Factors impacting therapy duration in children and adolescents with Paradoxical Vocal Fold Movement (PVFM)

Fujiki, Robert Brinton; Fujiki, Amanda; Thibeault, Susan L.

doi:10.1016/j.ijporl.2022.111182

Cited by 13 publications

(15 citation statements)

References 75 publications

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“…A comorbid behavioral health diagnosis was also observed to significantly increase the number of BCST sessions required before discharge. This aligns with past work indicating that a behavioral health diagnosis increased the duration of ILO therapy with a SLP in children 34 . In the current study, this phenomenon was largely driven by patients with GAD.…”

Section: Discussionsupporting

confidence: 91%

“…This aligns with past work indicating that a behavioral health diagnosis increased the duration of ILO therapy with a SLP in children. 34 In the current study, this phenomenon was largely driven by patients with GAD. This could be the result of patient anxiety symptoms or could be related to parental anxiety, as the condition has a documented hereditary component.…”

Section: Discussionmentioning

confidence: 55%

“…This occurred because therapy was adapted to address both cough suppression and dyspnea. ILO therapy has been shown to last an average of 3.4 sessions 34 ; thus, it is not surprising that patients with both cough and dyspnea symptoms required more time with the SLP.…”

Section: Discussionmentioning

confidence: 99%

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Factors influencing behavioral cough suppression therapy in children with nonspecific chronic cough

Fujiki,

Wright,

Fujiki

et al. 2023

Pediatric Pulmonology

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BackgroundBehavioral cough suppression therapy (BCST) with a speech–language pathologist is a common treatment for chronic nonspecific cough (a.k.a., tic cough) in children. Yet, the outcomes and duration of pediatric BCST have eluded formal investigation. This study examined whether BCST improves cough in children with nonspecific cough and factors that predict the course of treatment. Additionally, the cough characteristics and comorbidities associated with the condition were examined.MethodsA retrospective, observational cohort design was utilized. Cough characteristics, medical history, and BCST treatment details and outcomes for 151 children were extracted from the electronic medical record of a large outpatient pediatric otolaryngology clinic.ResultsCough was dry and onset unaccompanied by illness in most cases. Roughly half of patients reported gradual onset and cough proceeded by tickle. On average, patients experienced symptoms for 19 months (SD = 20.09) before diagnosis. Rates of comorbid General Anxiety Disorder were elevated compared to pediatric norms. Additionally, high rates of asthma (22.1%), reflux (62.3%), and disordered sleep breathing (19.2%) were observed. Common findings on laryngoscopy included interarytenoid edema and erythema. Vocal fold changes were observed in 22.9% of children. BCST reduced cough in 92.5% of patients following an average of 1.7 sessions. Comorbid behavioral health diagnoses (p = 0.013) or induced laryngeal obstruction symptoms (p = 0.025) were significant predictors of increased therapy sessions. Cough proceeded by tickle significantly predicted fewer sessions in therapy (p = 0.011).InterpretationAlthough randomized clinical trials are needed, these data suggest that BCST is a low‐risk, effective treatment for children with nonspecific cough.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 55%

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Factors influencing behavioral cough suppression therapy in children with nonspecific chronic cough

Fujiki,

Wright,

Fujiki

et al. 2023

Pediatric Pulmonology

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“…[38][39][40][41] Although formal behavioral health testing in pediatric patients has not been widely reported, evidence suggests a high prevalence of behavioral health comorbidities in individuals with EILO/ILO. 9,42,43 Patients with EILO have been observed seperately, 3,23,44,45 however, the 2 conditions have frequently been considered as one in research and clinical contexts. 13,18 As such, it is unclear to what extent EILO, ILO, and EILO+ differ one from another.…”

Section: Introductionmentioning

confidence: 99%

“…12,54,55 This therapy has generally been reported to be effective, 44,53,[56][57][58] and pediatric EILO/ILO/EILO+ patients have required an average of 3.4 therapy sessions before symptoms are sufficiently reduced for discharge. 42 However, understanding the manner in which EILO/ILO/EILO+ patients with varying symptom triggers respond to treatment may allow for optimization and individualization of therapy.…”

Section: Introductionmentioning

confidence: 99%

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

Fujiki,

Olson-Greb,

Thibeault

2023

Ann Otol Rhinol Laryngol

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Purpose: To compare clinical profiles of pediatric patients with Induced Laryngeal Obstruction (ILO), Exercise Induced Laryngeal Obstruction (EILO), and EILO with non-exertion related secondary triggers (EILO+). Methods: A retrospective observational cohort design was employed. Four-hundred and twenty-three patients <18 years of age were identified from the electronic medical record of a large children’s hospital. All patients underwent evaluations with a laryngologist and speech-language pathologist and were diagnosed with EILO/ILO. Patients were divided into 3 groups based on dyspnea triggers reported in initial evaluations. Groups consisted of patients with EILO (N = 281), ILO (N = 30), and EILO+ (N = 112). Patient demographics, EILO/ILO symptoms, endoscopy findings, medical comorbidities, medical history, and EILO/ILO treatment information were extracted and compared across EILO/ILO subtypes. Results: Patients with EILO experienced higher rates of hyperventilation ( P < .001), sore throat ( P = .023), and chest pain ( P = .003). Patients with ILO were significantly younger in age ( P = .017) and presented with increased rates of nighttime symptoms ( P < .001), globus sensation ( P = .008), self-reported reflux symptoms ( P = .023), and history of gastrointestinal conditions ( P = .034). Patients with EILO+ were more likely to be female ( P = .037) and presented with higher prevalence of anxiety ( P = .003), ADHD ( P = .004), chest tightness ( P = .030), and cough ( P < .001). Conclusions: Patients with EILO, ILO, and EILO+ present with overlapping but unique clinical profiles. A prospective study is warranted to determine the etiology of these differences and clarify how the efficacy of EILO, ILO, and EILO+ treatment can be maximized. Level of Evidence: 4

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

Fujiki,

Thibeault

2024

JAMA Otolaryngol Head Neck Surg

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ImportancePatients with induced laryngeal obstruction (ILO) present with a variety of behavioral health profiles. Identifying these profiles is crucial in that behavioral health conditions may affect treatment duration and outcomes.ObjectiveTo characterize the prevalence of anxiety, depression, posttraumatic stress disorder (PTSD), and physical somatic symptoms in adult and pediatric patients with ILO and determine the factors associated with anxiety, depression, PTSD, and physical somatic symptoms in patients with ILO?Design, Setting, and ParticipantsThis cross-sectional study included a nonprobability sample of 83 adult and 81 pediatric patients diagnosed with ILO at outpatient adult and pediatric otolaryngology clinics between 2021 and 2023. Exclusion criteria included a comorbid respiratory diagnosis other than asthma, head or neck cancer, or neurological impairments. Recruitment took place between September 2021 and March 2023. The analyses were run in January 2024.Main Outcome MeasuresPatients were prospectively screened for anxiety, depression, PTSD, and somatic physical symptoms. In addition, any past behavioral health diagnoses were extracted from the medical record. Comorbidities, ILO symptoms triggers, and onset details were gathered from ILO evaluations. Adult patients completed the Screen for Adult Anxiety Related Disorders (SCAARED), depression (Patient Health Questionnaire [PHQ]-9), and somatic physical symptoms portions of the Patient Health Questionnaires (PHQ-15), and the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5). Pediatric patients completed the Screen for Child Anxiety Related Disorders (SCARED), depression (PHQ-9A) and somatic physical symptoms portions of the Patient Health Questionnaires for Adolescents (PHQ-15A), and the UCLA PTSD Reaction Index brief screeners.ResultsEighty-three adult patients participated in this study (mean [SD] age, 45.8 [14.3] years; 64 female, 19 male). Eighty-one pediatric patients participated (mean [SD] age, 13.83 [2.55] years; 67 female, 14 male). Adult and pediatric patients with ILO screened positive for elevated rates of anxiety (53 adults [63%]; 49 children [60%]), depression (27 adults [32%]; 25 children [30%]), and PTSD (29 adults [34%]; 13 children [16%]). Most of the patients with anxiety and depression symptoms were formally diagnosed prior to ILO evaluation, with rates of previously diagnosed anxiety, depression, and PTSD also above published norms. Adults were twice as likely as children to present with PTSD (odds ratio, 2.1; 95% CI, 0.05-4.48). Elevated rates of physical somatic symptoms were also evident, with 38 adults (45%) and 32 children (39%) scoring in the moderate to severe range.Conclusions and RelevanceThis study found high rates of adult and pediatric patients with ILO screened positive for anxiety, depression, and PTSD symptoms. Future work should investigate how behavioral health and ILO treatments can best be coordinated to maximize treatment outcomes.

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Factors impacting therapy duration in children and adolescents with Paradoxical Vocal Fold Movement (PVFM)

Cited by 13 publications

References 75 publications

Factors influencing behavioral cough suppression therapy in children with nonspecific chronic cough

Factors influencing behavioral cough suppression therapy in children with nonspecific chronic cough

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

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

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