Diagnosis of vocal cord dysfunction/inducible laryngeal obstruction: An International Delphi Consensus Study

Paul Leong; Anne E Vertigan; Mark Hew; Malcolm Baxter; Debra Phyland; James H Hull; Thomas L Carroll; Peter G Gibson; Vanessa M McDonald; Thomas Halvorsen; Hege Havstad Clemm; Maria Vollsæter; Ola Drange Røksund; Philip G Bardin; Vocal Cord Dysfunction/Inducible Laryngeal Obstruction Delphi Expert Panel

doi:10.1016/j.jaci.2023.06.007

Diagnosis of vocal cord dysfunction/inducible laryngeal obstruction: An International Delphi Consensus Study

J Allergy Clin Immunol. 2023 Oct;152(4):899-906. doi: 10.1016/j.jaci.2023.06.007. Epub 2023 Jun 20.

Authors

Affiliations

¹ Monash Lung Sleep Allergy & Immunology, Monash Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. Electronic address: paul.leong@monash.edu.
² Speech Pathology, John Hunter Hospital, Newcastle, Australia; Centre of Excellence in Treatable Traits, University of Newcastle, Newcastle, Australia.
³ Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; AIRMed, Alfred Hospital, Melbourne, Australia.
⁴ Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Ear Nose and Throat Surgery, Monash Health, Melbourne, Australia.
⁵ Royal Brompton Hospital, London, United Kingdom.
⁶ Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Mass.
⁷ Centre of Excellence in Treatable Traits, University of Newcastle, Newcastle, Australia; Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.
⁸ Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway; Faculty of Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway.
⁹ Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
¹⁰ Monash Lung Sleep Allergy & Immunology, Monash Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.

PMID: 37343843
DOI: 10.1016/j.jaci.2023.06.007

Abstract

Background: Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is characterized by breathing difficulties in association with excessive supraglottic or glottic laryngeal narrowing. The condition is common and can occur independently; however, it may also be comorbid with other disorders or mimic them. Presentations span multiple specialties and misdiagnosis or delayed diagnosis is commonplace. Group-consensus methods can efficiently generate internationally accepted diagnostic criteria and descriptions to increase clinical recognition, enhance clinical service availability, and catalyze research.

Objectives: We sought to establish consensus-based diagnostic criteria and methods for VCD/ILO.

Methods: We performed a modified 2-round Delphi study between December 7, 2021, and March 14, 2022. The study was registered at ANZCTR (Australian New Zealand Clinical Trials Registry; ACTRN12621001520820p). In round 1, experts provided open-ended statements that were categorized, deduplicated, and amended for clarity. These were presented to experts for agreement ranking in round 2, with consensus defined as ≥70% agreement.

Results: Both rounds were completed by 47 international experts. In round 1, 1102 qualitative responses were received. Of the 200 statements presented to experts across 2 rounds, 130 (65%) reached consensus. Results were discussed at 2 international subject-specific conferences in June 2022. Experts agreed on a diagnostic definition for VCD/ILO and endorsed the concept of VCD/ILO phenotypes and clinical descriptions. The panel agreed that laryngoscopy with provocation is the gold standard for diagnosis and that ≥50% laryngeal closure on inspiration or Maat grade ≥2 define abnormal laryngeal closure indicative of VCD/ILO.

Conclusions: This Delphi study reached consensus on multiple aspects of VCD/ILO diagnosis and can inform clinical practice and facilitate research.

Keywords: Delphi; Vocal cord dysfunction; diagnostic criteria; inducible laryngeal obstruction; paradoxical vocal fold motion.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Airway Obstruction* / diagnosis
Australia
Delphi Technique
Humans
Laryngeal Diseases* / diagnosis
Vocal Cord Dysfunction* / complications
Vocal Cord Dysfunction* / diagnosis
Vocal Cords