Characterization of 68 Consecutive Pediatric Vocal Cord Dysfunction Clinic Patients.

Abstract

Purpose: Objectives were to characterize patients with inducible laryngeal obstruction (ILO), evaluate exercise-induced asthma (EIA) test results, and determine the need for future testing in this population.

Methods: A retrospective chart review was performed at a tertiary children's hospital on all pediatric patients seen in the Vocal Cord Dysfunction specialty clinic from February 2018 to February 2020. Demographics, medications, comorbidities, ILO triggers, symptoms, EIA test results, and follow-up otolaryngology and pulmonology appointment information were collected.

Results: Sixty-eight patients with ILO were identified at a median age of 14.5 (range: 9-18) years. Most were female (n = 50, 73.5%) and white (n = 65, 95.6%). Nearly all (92.6%) patients were triggered by exercise and 72.1% by laryngopharyngeal reflux. Almost all (98.5%) patients described difficulty breathing when triggered, with a third (35.3%) having stridor. Median time from initial symptoms to presentation was 12 months (range: 3 months-10 years) and median episode duration was 5 minutes (range: 30 seconds-3 hours). EIA testing was performed in 82.4%. Most (96.4%) patients did not exhibit an ILO episode during flexible fiberoptic laryngoscopy.

Conclusions: ILO benefits from a multidisciplinary team approach. Patients were triggered primarily by exertion or reflux, though the underlying behavioral health predispositions have not fully been explored.