Vocal Cord Dysfunction: Do Infections Drive Disease?

ABSTRACT

Rationale Vocal cord dysfunction (VCD) is often under-recognized and/or misdiagnosed as asthma. Although post-viral syndrome has been suggested as a contributing factor in VCD, there is little data on infectious-associated VCD and no information with COVID-19. The purpose of this ongoing, prospective registry study is to characterize risk factors contributing to VCD. Methods: Subjects age ≥ 12 years referred for VCD assessment at the time of provocation challenge-rhinolaryngoscopy were eligible to participate. Enrollment initiated September, 2021. An investigator designed questionnaire of potential risk factors for VCD including COVID-19 infection was administered with data chart collection. Results: Of 31 subjects currently enrolled, 52% (N=16) reported VCD symptoms either 1) onset following respiratory infection (N=9, 29%) or 2) worsened following COVID-19 infection (N=7, 23%). Those reporting infectious-associated VCD symptoms were more likely to report gastroesophageal reflux disease (p=0.017) with approaching significance for symptoms of throat clearing (p=0.097), chronic sinus infections (p=0.095), and age > 40 years (p=0.097) when compared to subjects who denied infectious-associated VCD symptoms. Additionally, the noninfectious-associated VCD group was approaching significance for reporting increasing number of triggers over time (p=0.051) versus infectious-associated VCD. There was no difference (p>0.05) between groups in Pittsburgh VCD Index scores, BMI, sex, co-morbid asthma, smoking status, environmental allergy history, or symptoms of shortness of breath, cough, wheezing, or throat tightness. Conclusions: Our early results suggest an important role for infectious etiologies, including COVID-19, in triggering and/or worsening VCD. Clinical awareness of these associations is warranted to rapidly address and provide appropriate therapeutic care.