Trauma-informed care improves management of paradoxical vocal fold movement patients

Vocal cord dysfunction (VCD) has been used by clinicians, primarily pulmonologists, to describe a variety of conditions in which the regulation and coordination of vocal fold movements are part of the explanation of cough or difficulty breathing, mainly paradoxical vocal fold motion disorder (PVFM). Prior studies show an intersection of mental health issues, primarily anxiety, and PVFM. We began incorporating mental health screening tools using the Life Events Checklist-5 (LEC-5) and the Posttraumatic Stress Disorder (PTSD) Checklist for Civilians (PCL-C) to assess symptomatology that may be related to traumatic life events. We seek to review the utility of these questionnaires for identifying patients who have experienced emotional trauma and use the principles of trauma-informed care currently lacking for PVFM.

We incorporated mental health screening tools using the PCL-C and LEC-5 for anyone referred to the Chicago Institute for Voice Care for VCD from the pulmonology clinic at our institution. Each patient underwent a comprehensive strobovideolaryngoscopy including provocative maneuvers to provoke paradoxical movements.

A total of 16 subjects were analyzed; of those, seven (43.8%) screened positive for PTSD with the PCL-C. Overall, 58 traumatic events occurred among the 16 patients, with 31 (61.7%) of the traumatic events occurring in the seven positively screened for PTSD.

Using the PCL-C and LEC-5, the principles of trauma-informed care principles were applied to patients initially referred for VCD who were found to have prior traumatic events. We recommend early mental health screening to establish a multidisciplinary team in PVFM.

3 Laryngoscope, 130:1508-1513, 2020.