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The Use of Aerodynamic Analysis in the Diagnosis of Adults with Paradoxical Vocal Cord Dysfunction

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The Use of Aerodynamic Analysis in the Diagnosis of Adults with Paradoxical Vocal Cord Dysfunction THE USE OF AERODYNAMIC ANALYSIS IN THE DIAGNOSIS OF ADULTS WITH PARADOXICAL VOCAL CORD DYSFUNCTION DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Kathleen Mary Treole, M.A. The Ohio State University 1996 Dissertation Committee: Approved by Professor Michael D. Trudeau, Adviser \jL nA Professor Janet M. Weisenberger Adviser Department of Professor Jessica R. Harris Speech and Hearing Science UMI Number: 9639361 Copyright 1996 by Treole, Kathleen Mary All rights reserved. UMI Microform 9639361 Copyright 1996, by UMI Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. UMI 300 North Zeeb Road Ann Arbor, MI 48103 ABSTRACT 50 adults with paradoxical vocal cord dysfunction (PVCD) and 50 adult, laryngeally normal adults control subjects were evaluated to determine which of 26 aerodynamic measurements in a clinical protocol differentiated the groups. Videolaryngostroboscopy (VLS) was performed on persons suspected of having PVCD to confirm the presence of abnormal vocal fold adduction and to determine if laryngeal lesion or abnormality (other than PVCD) contributed to the presentation of symptoms. Control subjects were examined via VLS to ensure structural and functional integrity of the larynx. The aerodynamic protocol included the following measures: vital capacity, phonatory volumes, mean flow of sustained phonemes (/a, s, z ,/), mean durations of sustained phonemes, rapid syllable repetitions (/a, ha/), spikes of flow during connected speech (reading, counting), cessations of flow during sustained phoneme tasks, and ratios of tasks (s/z, ha/a). The following measurements demonstrated a group effect in which control subjects demonstrated higher mean values than did subjects with PVCD: volumes, durations, and mean peak flow of /a/ and /ha/ repetitions. The following measurements demonstrated a group effect in which persons with PVCD demonstrated greater means than did control subjects: number of /a/ and /ha I repetitions, number of spikes of airflow >700 ml during connected speech tasks, and the number of cessations of airflow during sustained phonation tasks. The following measurements demonstrated a significant gender effect in which males demonstrated greater means than did females: volumes, durations of sustained tasks, mean flow of connected speech tasks, mean peak flow of /a/ and /ha/ repetitions, s/z ratio (flow), spikes of flow during connected speech tasks, and cessations of flow during sustained /s/. The following measurements demonstrated gender effects in which females demonstrated greater means than did males: cessations of flow during vital capacity, sustained /a/, and sustained /z/, and s/z ratios (phonatory volume and duration). These gender effects provide evidence that indicate males and females should be considered separately in the diagnosis of laryngeal disorders such as PVCD. Several main effects and interactions of main effects were also observed including volumes tasks, durations tasks, repetitions tasks, s/z ratios, and connected speech tasks. iii Post-hoc testing indicated that levels of these dependent variables different significantly. This may indicate that tasks which appear to be similar during production (e.g., sustained /s/ and /z/) cannot be interchanged during a diagnostic evaluation. The results of the present study are summarized to provide a typical aerodynamic profile of adult females with PVCD and adult males with PVCD. IV For my mother and father.. words alone cannot express my thanks, love, and appreciation for all you have done for me, always. ACKNOWLEDGMENTS I wish to thank Michael D. Trudeau, my adviser, for his unending support and guidance throughout my life at Ohio State. His great sense of humor, and direction, provided me with the strength to persevere. I am forever grateful to Jan Weisenberger, not only for her assistance with my dissertation, but for her friendship, support, foresight, hindsight, and instinct. I thank Jessica Harris for her thoughtful insight during this project, and for providing a model to strive to for as a new professor. I thank JoAnn Donohue for being president of my one-woman fan club who always lifted my spirits and provided me with inspiration to finish. Without the comic relief provided by Karen Hodge, I most assuredly would not have completed this unending task. I pass on to her the strength given to me by our friends and faculty as she begins her doctoral endeavor. 1 am ever grateful to L. Arick Forrest for the opportunity to grow as a professional in an environment with high expectations. I appreciate not only his guidance, but his friendship. I respectfully acknowledge the Department of Otolaryngology and the Department of Speech and Hearing Science. These departments provided me with the opportunity to succeed. Finally, without the love of my sisters, I would be nothing. vi VITA August 7, 1969 ....................................... Bom - Passaic, New Jersey 1991 .......................................................... B.S., Teacher of the Speech and Hearing Handicapped, Ithaca College 1993 ...........................................................M.A., Speech and Hearing Science, The Ohio State University 1991-1994 ...............................................Graduate Teaching Associate Department of Speech and Hearing Science The Ohio State University 1995-1996 ...............................................Provost’s Teaching Fellow The Ohio State University 1994-present ...........................................Speech-Language Pathologist The Ohio State University Voice Center The Department of Otolaryngology FIELDS OF STUDY Major Field: Speech and Hearing Science Minor Fields: Speech-language pathology Voice and voice disorders VII TABLE OF CONTENTS Page Abstract.............................................................................................................. ii Dedication .......................................................................................................... v Acknowledgments ...........................................................................................vi Vita................................................................................................................... vii List of Tables ................................................................................................... xii List of Figures ........................................................................................... xviii Chapters: 1. Introduction ..........................................................................................1 Statement of the problem ...................................................................4 Purpose of this study ..............................................................................5 Research questions ...............................................................................6 Volumes .............................................................................6 Mean flow of sustained phonation tasks ......................6 S/Z ratio obtained from sustained /s/ and /z/ tasks. ...6 Mean peak flow ................................................................6 Mean peak flow in connected speech tasks ..................6 Frequency of spikes of flow during connected speech tasks.....................................................................7 Frequency of cessations of flow during sustained phonation/expiration tasks ............................................ 7 Procedures ................................................................................... 8 Analyses of the data ................................................................ 8 Definitions of terms ................................................................. 9 Organization of the study .........................................................10 viii 2. Review of the literature............................................................................11 Introduction ........................................................................................ 11 Incidence/Prevalence ...................................................................... 13 Nomenclature .................................................................................... 15 Patient characteristics.....................................................................16 The paradoxical motion ................................................................ 18 Wheezing/stridor. .............................................................................. 20 Description of treatments ............................................................. 22 Physical treatments..............................................................22 Speech therapy........................................................................24 Psychiatric/psychologic treatments ................................. 28 Normal respiration .......................................................................... 28 Normal laryngeal behavior. ............................................................30 Possible etiologies of PVCD ....................................................... 39 Psychogenic ........................................................................... 41 Learned behavior/compensatory strategy .........................49 Neurological differences .....................................................52 Differential diagnosis ...................................................................
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