Vocal cord dysfunction: The importance of psychologic factors and provocation challenge testing

Selner, John C.; Staudenmayer, Herman; Koepke, Jerald W.; Harvey, Robert P.; Christopher, Kent L.

doi:10.1016/0091-6749(87)90203-x

Cited by 95 publications

(67 citation statements)

References 15 publications

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“…Psychological factors such as anxiety or trauma have been linked to this syndrome~Gavin, Wamboldt, Brugman, Roesler, & Wamboldt, 1998;Selner, Staudenmeyer, Koepke, Harvey, & Christopher, 1987!, and it is yet unknown whether qualitatively similar upper airway effects can be expected in healthy individuals in anxiety or stressful situations. Usually these effects are most apparent during inhalation, and the disorder is often diagnosed by abnormal inspiratory flow in spirometry tests.…”

Section: Vocal Cord Disordermentioning

confidence: 99%

Guidelines for mechanical lung function measurements in psychophysiology

Ritz¹,

Dahme²,

DuBois³

et al. 2002

Psychophysiol.

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Studies in psychophysiology and behavioral medicine have uncovered associations among psychological processes, behavior, and lung function. However, methodological issues specific to the measurement of mechanical lung function have rarely been discussed. This report presents an overview of the physiology, techniques, and experimental methods of mechanical lung function measurements relevant to this research context. Techniques to measure lung volumes, airflow, airway resistance, respiratory resistance, and airflow perception are introduced and discussed. Confounding factors such as ventilation, medication, environmental factors, physical activity, and instructional and experimenter effects are outlined, and issues specific to children and clinical groups are discussed. Recommendations are presented to increase the degree of standardization in the research application and publication of mechanical lung function measurements in psychophysiology.Descriptors: Mechanical lung function, Airway resistance, Respiratory resistance, Spirometry, Pneumotachography, Body plethysmography, Forced oscillation technique, Interrupter technique, Respiratory perception Despite long-standing interest in respiration by psychophysiologists, it is surprising that little attention has been directed to methodological issues of specific measurement techniques in this area. Although occasional textbook chapters have been devoted to respiration measurements, a more in-depth discussion of techniques dealing with the assessment of mechanical lung function is still missing. Mechanical lung function relates to lung volumes and airflow through the respiratory system as well as the pressurevolume and pressure-flow characteristics as indicators of elastic and resistive properties of the airways, lungs, and chest wall. In clinical practice, mechanical lung function measures are widely used for the diagnosis and management of various pulmonary diseases, most importantly bronchial asthma and chronic obstructive pulmonary disease~COPD!. In psychophysiology and behavioral medicine, potential associations between psychological or behavioral processes and mechanical lung function offer an exciting perspective both for basic research and clinical application. Due to the particular importance of the vagal system in governing airway function, the airways offer a unique window into the autonomic nervous system regulation of behavior, emotion, and cogThomas Ritz acted as coordinator and contributor to this report. The authorship of the other contributors was determined by alphabetical order. Different sections were drafted by individual contributors, submitted to internal peer review, and revised until consensus was achieved. We are indebted to

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Section: Vocal Cord Disordermentioning

confidence: 99%

Guidelines for mechanical lung function measurements in psychophysiology

Ritz¹,

Dahme²,

DuBois³

et al. 2002

Psychophysiol.

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“…Psychotherapy also has benefited some patients, by helping patients to identify and manage issues of primary and secondary gain associated with VCD. 4 The high prevalence of anxiety-related disorders in patients with VCD has led to the suggestion that anxiolytics may benefit patients, although this is not generally used as a first-line therapeutic option. 2 The patient in this report demonstrated an ability to control VCD with hypnosis, as has been reported previously for other patients.…”

Section: Discussionmentioning

confidence: 99%

“…To maximize diagnostic yield during laryngoscopy, provocation of symptoms using methacholine, histamine, or exercise challenges have been used. 3,4 We report a case wherein hypnotic suggestion was used as an alternative method to achieve a diagnosis of VCD.…”

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confidence: 99%

Hypnosis as a Diagnostic Modality for Vocal Cord Dysfunction

Anbar

Hehir

2000

Pediatrics

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ABSTRACT. Vocal cord dysfunction (VCD) is a condition of paradoxical adduction of the vocal cords during the inspiratory phase of the respiratory cycle. VCD often presents as stridorous breathing, which may be misdiagnosed as asthma. The mismanagement of this disorder may result in unnecessary treatment and iatrogenic morbidity. An association with psychogenic factors has been reported, and a higher incidence of anxiety-related illness has been demonstrated in patients with VCD.Definitive diagnosis of VCD is made by visualization of adducted cords during an acute episode using nasopharyngeal fiber-optic laryngoscopy. Diagnosis can be problematic, because it may be difficult to reproduce an attack in a controlled setting. To maximize diagnostic yield during laryngoscopy, provocation of symptoms using methacholine, histamine, or exercise challenges have been used. We report a case of an 11-year-old boy, wherein hypnotic suggestion was used as an alternative method to achieve a diagnosis of VCD.The patient was admitted to the pediatric intensive care unit for elective fiber-optic laryngoscopy to confirm a diagnosis of VCD. The patient had a 4-year history of refractory asthma, severe gastroesophageal reflux disease (GERD) for which he had undergone a Nissen fundoplication, and suspected VCD.At 9 years of age the patient began manifesting monthly respiratory distress episodes of a severe character different from those that had been attributed to his asthma. Typically, he awoke from sleep with shortness of breath and difficulty with inhalation. He described a "neck attack" during which he felt as if the walls of his throat were "beating together." The patient was at times noted by his mother to exhibit a "suckling" behavior before onset of his respiratory distress episodes. On 4 occasions the patient became unconscious during an attack and then spontaneously regained consciousness after a few minutes. On these occasions, he was transported by ambulance to the hospital and the severe difficulty with inhalation resolved within a few minutes on treatment with oxygen and bronchodilators. Sometimes he was noted to manifest wheezing for several hours, which was responsive to bronchodilator therapy.Given the severity of the patient's disease, it was imperative to determine whether VCD was a complicating factor. It was proposed that an attempt be made to induce VCD by hypnotic suggestion while the patient underwent a fiberscopic laryngoscopy to establish a definitive diagnosis. The patient and his mother gave written consent for this procedure. He was admitted for observation to the pediatric intensive care unit for the induction attempt. The patient requested that no local anesthesia be applied in his nose before passage of the laryngoscope because he wanted to eat right after the procedure. Therefore, the nasopharyngeal laryngoscope was inserted while he used self-hypnosis as the sole form of anesthesia. He demonstrated no discomfort during its passing. Once the vocal cords were visualized, the patient was instructed to de...

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“…Organic reasons include brain stem compression, cortical or upper motor neuron damage, gastroesophageal reflux, nuclear or lower motor neuron damage while nonorganic reasons include simulative behaviors and conversion disorders. [18][19][20] PVCM is most frequently seen in young women. [19] In our study, 64% of the patients were female and their mean age was 36.3±4.5 years.…”

Section: Journal Of Medical Updatesmentioning

confidence: 99%

Evaluation of paradoxical vocal cord motion and differential diagnosis

Yalçınkaya¹

2014

J Med Updates

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Vocal cord dysfunction: The importance of psychologic factors and provocation challenge testing

Cited by 95 publications

References 15 publications

Guidelines for mechanical lung function measurements in psychophysiology

Guidelines for mechanical lung function measurements in psychophysiology

Hypnosis as a Diagnostic Modality for Vocal Cord Dysfunction

Evaluation of paradoxical vocal cord motion and differential diagnosis

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