CHARACTERIZATION OF LARYNGEAL DISORDERS IN PATIENTS WITH EXCESSIVE CENTRAL AIRWAY COLLAPSE

Abstract

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Tracheobronchomalacia and excessive dynamic airway collapse are conditions affecting the trachea and mainstem bronchi leading to respiratory symptoms through excessive central airway collapse (ECAC) during expiration. Patients with this condition often present with laryngeal pathology resulting in hoarseness, shortness of breath, dysphagia, or cough. Despite previous descriptions of the incidence of paradoxical vocal fold motion in this population, the various possible laryngeal abnormalities have not been characterized. METHODS: We performed a retrospective review of our prospectively collected institutional tracheobronchomalacia database. The most recent patients seen at the chest disease center during the previous and current year (2019-2020) were evaluated. Demographics, comorbidities, previous airway surgeries, and laryngoscopy results were included. Continuous outcomes are presented as means or medians based on the assessment of normality (Shapiro-Wilk test). Dichotomic outcomes are presented as proportions. RESULTS: A total of seventy patients were included in the study. The median age was 57 (49 – 64) and 55 patients were female (78.6%). The most common comorbidities were asthma in 46 (66.7%), gastroesophageal reflux in 41 (59.4%), and obstructive sleep apnea in 32 (46.4%) patients. Only 4 (5.8%) patients had a previous tracheostomy, while 7 (10.1%) had had a previous airway surgery. Out of 70 patients, 64 (91.4%) were evaluated by the laryngology service. Of the patients that were evaluated, 53 (82.8%) had at least one abnormality in their larynx. The most common findings were laryngeal hyperfunction/muscle tension dysphonia in 34 (53.1%), signs of laryngopharyngeal reflux in 27 (42.2%), and vocal fold hypomobility/paresis in 25 (39.1%) patients. More severe conditions like paradoxical vocal fold motion, laryngospasm, and vocal fold paralysis were present in 13 (20.3%), 2 (3.1%), and 2 (3.1%) patients respectively. CONCLUSIONS: ECAC patients have a high incidence of laryngeal disorders that may contribute to their respiratory symptomatology and deteriorate their health-related quality of life. For this reason, it is important to have a baseline laryngeal evaluation before any airway intervention, especially when respiratory symptoms are out of proportion to the degree of dynamic central airway collapse. CLINICAL IMPLICATIONS: Laryngeal pathology may be an additional cause of symptoms in patients with ECAC that can be overlooked if a detailed laryngoscopy evaluation is not conducted. Early identification and opportune intervention could lead to improved patient-centered outcomes. DISCLOSURES: No relevant relationships by Alex Chee, source=Web Response No relevant relationships by Sidhu Gangadharan, source=Web Response No relevant relationships by Fayez Kheir, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with cook medical Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Pavan Mallur, source=Web Response No relevant relationships by Daniel Ospina-Delgado, source=Web Response No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Jennifer Wilson, source=Web Response