Presentations

Abstract

Introduction:

Vocal Cord Dysfunction (VCD) entails an atypical closure of the vocal cords during inspiration, often mistaken for refractory asthma. Symptoms encompass dyspnea, throat tightness, stridor, dysphonia, and asthma-like manifestations such as coughing and wheezing. VCD triggers include exercise, emotional responses, reflux, and various environmental factors. While laryngoscopy serves as the traditional diagnostic method, historical context and pulmonary function assessments also provide valuable diagnostic insights. Our objective is to elucidate the relationship between VCD and psychiatric conditions, particularly depression, anxiety, and ADHD. This study aims to enhance diagnostic precision and contribute to improved therapeutic strategies in the realm of pediatric healthcare.

Materials and Methods:

Retrospective chart review conducted on patients diagnosed with VCD in a Children´s Hospital in the U.S. from September 1, 2017 - September 1, 2022. Inclusion criteria included pediatric patients with VCD up to 21 years old. Exclusion criteria included patients with chest deformities, vocal cord paralysis, history of intubation, or discrepancies in diagnosis between ENT, Allergy, or Pulmonology regarding diagnosis. In addition to the chart reviews from the specialties mentioned above, we included clinical notes from Psychiatry, primary Pediatrician, and Speech Therapy to obtain a detailed mental health history, medications, involvement in sports and any signs of exercise- induced VCD. For our statistical analysis, we first compiled all data points into an Excel database to ensure uniformity. Once compiled, the raw data were systematically grouped based on predefined categories relevant to our study objectives, and percentages were calculated. Throughout the data collection, we conducted periodic random sampling checks to ensure accuracy and maintain the integrity of our data.

Results:

From a gender perspective, females were predominant at 85%, with males at 15%. Remarkably, 78% had at least one mental health condition and 48% were on medications for anxiety, MDD, or ADHD. The distribution of psychiatric comorbidities showed that 74% had anxiety, 27% had ADHD, and 26% were diagnosed with MDD. Among individuals diagnosed with a psychiatric condition, at least 69% exhibited exercise-induced VCD. Additionally, 62% took part in competitive sports, with swimming and soccer as the predominant choices.

Conclusions:

We noticed a significant gender difference in VCD prevalence, with females accounting for a substantial 85% of cases. This is consistent with broader VCD literature, suggesting possible hormonal, anatomical, or psychosocial factors predisposing females to this condition. Nearly 8 out of 10 individuals had at least one diagnosed mental health condition, emphasizing the complex relationship between VCD and mental health. These findings highlight the importance of a comprehensive approach to diagnosing and managing VCD, addressing both its physiological and psychological aspects. The high prevalence of exercise-induced VCD among individuals with psychiatric conditions emphasizes the need for increased awareness and specialized care strategies, particularly for young athletes. Future research should explore deeper into the mechanisms linking VCD to psychological conditions and explore targeted interventions for affected individuals.