Midazolam for treatment of therapy resistant MTD and VCD
Research type
Research Study
Full title
A prospective cohort study measuring the symptom improvement of adminsitering intravenous midazolam combined with speech and language therapy (SLT) in five patients with treatment resistant muscle tension dysphonia (MTD) and Vocal Cord Dysfunction (VCD)
IRAS ID
118957
Contact name
Siobhan Lillie
Contact email
Sponsor organisation
LTHTR
Research summary
Vocal Cord Dysfunction (VCD) is a respiratory condition characterised by abnormal closure of the vocal cords whilst breathing in, out or both. Patients with VCD typically present with episodes of respiratory distress that are associated with stridor, cough, choking sensations, and throat tightness. Often due the abnormal movement of the vocal cords and the increased effort needed to breathe, patients also present with a muscle tension dysphonia (MTD). Muscle tension dysphonia is a voice abnormality characterised by increased tension in the laryngeal framework and in the surrounding neck musculature.
Vocal Cord Dysfunction is diagnosed by clinical history and symptomatology alongside a flexible laryngoscopy. A laryngoscopy is a small camera that goes to the back of the nose and allows us to visualise the nose and throat. Patients will present with abnormal vocal cord movements on breathing in, out or both when symptomatic. Often when patients are not symptomatic they will still present with constriction in the laryngeal muscles and often use their false cords when speaking.
The physical symptoms of VCD are often managed with SLT exercises which reduce the muscle tension in the laryngeal framework and breath control techniques to increase awareness of abdominal breathing and relaxation of the throat muscles. Many patients will also see physiotherapy for dysfunctional breathing patterns and/or psychology as anxiety and stress can be triggers of VCD. The majority of patients respond well to these interventions and are able to manage their breathlessness and voice problems effectively. A minority of patients do not respond to the standard therapies and this is likely to be linked to the severity of the MTD.
We feel that administering a light dose of intravenous midazolam whilst completing SLT may be a useful tool to change fixed laryngeal muscle tension patterns in patients with VCD and MTD.
REC name
North West - Preston Research Ethics Committee
REC reference
13/NW/0633
Date of REC Opinion
13 Nov 2013
REC opinion
Further Information Favourable Opinion