So Raymond J, Jenks Carolyn, Yi Julie, Ryan Marisa A, Tunkel David E, Walsh Jonathan M
Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Int J Pediatr Otorhinolaryngol. 2022 Nov;162:111304. doi: 10.1016/j.ijporl.2022.111304. Epub 2022 Sep 2.
Paradoxical vocal fold motion (PVFM) is not well-characterized in infants. Sex- and race/ethnicity-based differences have been described in older children with PVFM. This study's objectives are to characterize demographic and clinical characteristics of infants diagnosed with PVFM and investigate sex- and race-specific differences in presentation.
We retrospectively reviewed infants ≤1 year of age diagnosed with PVFM at our institution from 2009 to 2019. Patient demographics, symptoms, and findings on flexible laryngoscopy are described. Sex- and race/ethnicity-based differences were assessed using Fisher's exact test analyses.
We identified 22 infants who were diagnosed with PVFM. The average age (range) at diagnosis was 5.7 (0.25-12.0) months, and 45.5% were male. The majority (54.6%) of patients identified as non-Hispanic White. Common comorbidities included GERD (45.5%) and chronic rhinitis (13.6%). Stridor was the only presenting symptom in the majority of patients (95.4%). The most common episode triggers were crying (45.5%), feeding (27.3%), and gastric reflux (9.1%). On flexible laryngoscopy, PVFM was observed in 95.5% of patients. A third of patients (31.8%) were misdiagnosed as having reactive airway disease or laryngomalacia prior to evaluation by otolaryngology. No sex- and race/ethnicity-based differences in presentation were identified.
We present the largest case series of PVFM in infants. We found sparse clinical signs/symptoms other than stridor and a high incidence of misdiagnosis, which supports the importance of objective flexible laryngoscopy for the evaluation of stridor in this age group. Previously reported sex- and race/ethnicity-based differences in presentation of PVFM were not observed in this cohort of infants.
矛盾性声带运动（PVFM）在婴儿中的特征尚未得到充分描述。在患有PVFM的大龄儿童中，已描述了基于性别和种族/民族的差异。本研究的目的是描述被诊断为PVFM的婴儿的人口统计学和临床特征，并调查其在表现上的性别和种族差异。
我们回顾性分析了2009年至2019年在我院诊断为PVFM的1岁及以下婴儿。描述了患者的人口统计学、症状以及纤维喉镜检查结果。使用Fisher精确检验分析评估基于性别和种族/民族的差异。
我们确定了22例被诊断为PVFM的婴儿。诊断时的平均年龄（范围）为5.7（0.25 - 12.0）个月，45.5%为男性。大多数患者（54.6%）为非西班牙裔白人。常见的合并症包括胃食管反流病（GERD，45.5%）和慢性鼻炎（13.6%）。喘鸣是大多数患者（95.4%）唯一的就诊症状。最常见的发作诱因是哭闹（45.5%）、喂食（27.3%）和胃反流（x.1%）。在纤维喉镜检查中，95.5%的患者观察到PVFM。三分之一的患者（31.8%）在耳鼻喉科评估之前被误诊为患有反应性气道疾病或喉软化症。未发现基于性别和种族/民族的表现差异。
我们展示了最大的婴儿PVFM病例系列。我们发现除喘鸣外临床体征/症状稀少且误诊率高，这支持了客观的纤维喉镜检查对评估该年龄组喘鸣的重要性。在这组婴儿中未观察到先前报道的PVFM表现中基于性别和种族/民族的差异。
