Vocal cord dysfunction in the pediatric age group

Purpose: The retrospective study was designed to assess treatment outcome in a sample of pediatric patients with vocal cord dysfunction (VCD), a functional upper airway obstruction characterized by involuntary paradoxical movement of the vocal cords. Methods: Medical charts of 21 subjects between the ages of 8 and 19 years (median age 15 years) were reviewed, 7 male and 14 female. The sample included all patients seen in a tertiary care pediatric pulmonary clinic for VCD over 4 years and 5 months that had confirmatory bronchoscopy or laryngoscopy. The subjects or their parents were contacted by telephone 11-62 months (median 20 months) after initial diagnosis and a standardized interview was conducted. Results: In the initial medical evaluations, isolated VCD was present in 15 subjects with normal spirometry, and VCD and asthma were both present in 6 subjects. Four subjects received a diagnosis of significant psychological disorder at the time of evaluation. Presenting symptoms included cough, wheezing, chest pain, choking, stridor, hoarse voice, dizzyness .The most frequent triggers were exercise and irritants. Fifteen of the original 21 subjects were reached for telephone interview.All 15 had received intervention, including cognitive-behavioral psychotherapy, speech therapy, general psychotherapy, or a combination of these treatments.Twelve subjects received 3 to 6 sessions of treatment and three required treatment greater than 1 year. Most subjects reported significant improvement in symptoms (54% "a lot better", 13% "a little better", 33% "unchanged") and activity level (60% more active,33% no change, 7% less active). There were no hospital admissions since evaluation in 13 of the subjects and no emergency room visits for 11. Conclusions: VCD is a previously underrecognized disorder that is more common in females than males and is characterized by respiratory symptoms often confused with asthma. The majority of subjects in our study did not have a significant premorbid psychological disorder and most responded well with improved functioning and fewer symptoms to brief intervention. A small subgroup required more intense psychological treatment. Clinical Implications: Patients with activity induced respiratory symptoms and normal spirometry who do not respond to conventional treatment for asthma should be evaluated for VCD with appropriate referral for brief intervention.