Does Flattened Inspiratory Loop Lead to Diagnosis of Pediatric PVFM?

Monday, October 2, 2023

2:33 PM - 2:39 PM East Coast USA Time

Location: 207CD

Presenting Author(s)

Anna N. Berezovsky, MD

PGY 4
Medical College of Wisconsin
Milwaukee, WI, United States

Co-Author(s)

DF

David R. Friedland, MD PhD

Professor
Medical College of Wisconsin-Department of Otolaryngology and Communication Sciences
Milwaukee, Wisconsin, United States
SD

Sara Dawson, MD

Medical College of Wisconsin-Department of Pulmonology, USA
LA

Louella Amos, MD

Medical College of Wisconsin-Department of Pulmonolgy, USA
Jazzmyne A. Adams, MPH

Director
Medical College of Wisconsin-Department of Otolaryngology and Communication Sciences
Milwaukee, WI, United States
PB

Phuong H. Bao, n/a

Medical College of Wisconsin, USA

Senior Author(s)

RC

Robert H. Chun, MD

PROFESSOR
MEDICAL COLLEGE OF WISCONSIN
Milwaukee, WI, United States

Introduction: Paradoxical vocal fold motion (PVFM) is a common referral to pediatric otolaryngologists as the gold standard for diagnosis is visualization of vocal cord adduction with inspiration on flexible laryngoscopy. Pediatric studies in PVFM have been limited and there are gaps in knowledge in presentation and diagnosis of these patients. We aim to assess ENT consultation following pulmonary function testing (PFT) to assess for PVFM.

Methods: Retrospective observational cohort study which assessed all children between the ages of 0 and 17 with outpatient referrals to ENT within 6 months of PFT testing from 2017 to 2022 who underwent flexible laryngoscopy. Group comparisons were composed of odds ratios (OR) with 95% confidence intervals and associated p-values.

Results: A total of 387 patients were seen in ENT clinics following PFTs with 72 of these referrals presenting for PVFM assessment. 52 (72.22%) of the patients were female, mean age was 13.08+/-2.87. 36 (50%) of these referrals were placed by pulmonary providers and 36 (50%) came from allergy providers. 13 (18.06%) patients had PVFM findings on laryngoscopy with a total of 35 patients (48.61%) being diagnosed with PVFM. No subglottic stenosis, paresis, or masses were noted on scope. Flattening of the inspiratory loop of the flow volume curve was not significantly associated with increased PVFM findings on flexible laryngoscopy, OR=0.97 (0.28, 3.34) p=0.19, or PVFM diagnosis in general, OR= 1.54 (0.59,4.06) p=0.48.

Conclusions: PVFM referrals to ENT clinics are not infrequent following pulmonary function testing from pulmonary and allergy clinics. The present study did not find correlations between inspiratory findings on flow volume loops and PVFM diagnosis.